The decision: Relations to oneself, authority and vulnerability in the field of selective abortion

Shouldering Death: Moral Tensions, Ambiguity, and the Unintended Ramifications of State-sanctioned Second-trimester Selective Abortion in Denmark

This article is based on an ethnographic study of pregnant couples' embodied, emotional, and moral experiences of second-trimester selective abortion in Denmark. Drawing on 16 selective abortion stories, I unpack the intense, often highly accelerated, days that follow from the moment a fetal aberration is detected to the moment of fetal disposal or burial. I show that although prenatal screening and diagnostics have come to occupy a routinized part of pregnancy in Denmark, when women and their partners opt for termination, they are faced with a series of bodily events and actions they are entirely unprepared for while at the same time feeling essentially alone in grappling with the moral confusion that ensues. I argue that despite widespread medico-legal sanctioning and social endorsement of selective abortion, the specificities of how such terminations are done in Denmark in ambiguous, and conflicted, ways situate women and their partners in a series of moral tensions around how to relate to the abortion, the dead fetus, their grief, and their entitlement to such mourning. By chronicling the core struggles that the process of termination catalyzes, I point to the social and moral ramifications of the embodied practices and medico-legal choreographing of selective abortion in Denmark. [selective abortion, moral tensions, embodied practices, responsibility, death].

Postponed Withholding: Balanced Decision-Making at the Margins of Viability

Advances in neonatology have led to improved survival for periviable infants. Immaturity still carries a high risk of short- and long-term harms, and uncertainty turns provision of life support into an ethical dilemma. Shared decision-making with parents has gained ground. However, the need to start immediate life support and the ensuing difficulty of withdrawing treatment stands in tension with the possibility of a fair decision-making process. Both the parental "instinct of saving" and "withdrawal resistance" involved can preclude shared decision-making. To help health care personnel and empower parents, we propose a novel approach labeled "postponed withholding." In the absence of a prenatal advance directive, life support is started at birth, followed by planned redirection to palliative care after one week, unless parents, after a thorough counseling process, actively ask for continued life support. Despite the emotional challenges, this approach can facilitate ethically balanced decision-making processes in the gray zone.

Parental experiences after prenatal diagnosis of fetal abnormality

For many pregnant women, prenatal testing is a routine component of contemporary pregnancy care. Receiving a prenatal diagnosis is frequently associated with intense feelings of shock and grief; the extent of which may be unrelated to the pregnancy gestation or the condition diagnosed. During this time of crisis, parents are often faced with important choices about their pregnancy. Levels of understanding and experiences of professional support throughout this time likely impact decisions that are made and how they are subsequently perceived. Despite considerable advances in prenatal testing technologies over the last 20 years there is a paucity of research examining parental experiences in-depth. Future advances such as prenatal exome sequencing will further increase the scope of prenatal testing and numbers of parents who receive a prenatal diagnosis. It is imperative that large-scale studies are performed to ensure that protocols are in place to adequately support couples at this time.

Coming to terms with the imperfectly normal child: attitudes of Israeli parents of screen-positive infants regarding subsequent prenatal diagnosis

This study examines the interface between newborn screening and prenatal diagnosis from the point-of-view of parents of screen-positive children. Many conditions covered by newborn screening represent classic (autosomal recessive) Mendelian disorders. Parents of screen-positive infants therefore often come to learn that they are carriers of the disease, and face a decision whether to test for it in future pregnancies. Semi-structured interviews were conducted in 2015-2017 with 34 Israeli parents whose child was screen positive. Three major themes emanated from the parents' attitudes toward prenatal testing for the disease in prospective hypothetical pregnancies: rejection of prenatal testing for the disease associated with the screen positive, and relying instead on newborn screening to reveal if a future baby is also sick (18/34, 53%); support of prenatal testing to get more information (7/34, 21%) and support of prenatal testing in order to abort in case of a test positive (9/34, 26%). We discuss the importance of newborn screening for reproductive decision-making, highlighting the arguments associated with positive and negative parental views of the possibility of having another child with the same condition associated with the screen-positive of the child that had already been born. The conclusions challenge the common assertion that parents pursue the dream of the "perfect child" through prenatal diagnosis that "naturally" leads to selective abortion. The diversity of views expressed by Israeli parents of screen-positive children highlights the diversity of normative scripts of "genetic responsibility" in the context of parenthood.