Challenging the Rhetoric of Choice in Prenatal Screening

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Challenging the Rhetoric of Choice in Prenatal
Screening

• Victoria Seavilleklein

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Increases Autonomy

• Increases to number of pregnant women screened
  and increase in things they are screened for.
• Typically justified in terms of greater autonomy
  for pregnant women.
• Seavillekleins thesis Screening does not prtet
  or promote womens autonomy in most cases (on
  various notions of autonomy).

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Autonomy and Informed Consent

• Autonomy in health care achieved through informed
  consent which is comprised by person is
  competent adequate disclosure about the
  intervention adequate understanding about the
  intervention voluntary consent.
• Lots of evidence to support that in the vast
  majority of cases, at least one of these
  conditions is missing.

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Disclosure

• Supposed to disclose details about the conditions
  being screened for, the liklihood of detection,
  the method of screening, the meaning of a
  screen-positive and a screen- negative result,
  the choices following a screen-positive result,
  the choices following a a positive diagnosis, and
  details on how further info can be attained.
• Far too little time devoted to this (b/w 2-5
  minutes) for it to occur.

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Understanding

• Studies indicate that understanding is rare.
• Probabilities difficult to understand. Increased
  probability typically take to mean their child
  is going to have the disease or they have a 50/50
  chance of getting it. But it could be that the
  chances of their child being inflicted with a
  particular disease rises from 1 in 400 to 1 in
  250.

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Voluntariness

• Stats that women were not asked to consent. E.g.,
  screening was done in conjunction with standard
  blood tests without the knowledge of the women
  (284).
• Physicians power and their worry about law suits.

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A Relational View

• Standard, individualist view of autonomy vs.
  relational view. The latter takes into account
  the context (and, e.g., power relationships) of
  the decision maker.
• Business interests factors and the creation of
  demand (think of Orgasm, Inc.) Only giving woman
  want they want?
• More information is better? Contraception and
  large families
• More choice is always good? Choices becoming
  compulsions.
• Safety Usually recommended. at risk (vs.
  what, No risk?
• Ultrasonography now a standard part of pre-natal
  care despite no evidence of its clinical value.

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A relational view

• Womens actual choices and options vs. the ones
  medical profession allows.
• E.g., Abortion OK at 20 weeks for Downs
  Syndrome, but not sex selection.
• Social supports for various decisions e.g., to
  give birth to a baby with severe disabilities.

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Conclusion

• NOT opposed to pre natal screening.
• But wants us to think more deeply about womens
  real choices.
• We need to take steps to improve the process of
  informed consent.
• Address contextual factors that restrain choice
• Incorporating the offer of prenatal as a standard
  perinatal care ought to be rethought.