Risk and anxiety: Polyvalence of ethics in high-tech antenatal care

'Have you had the test?' A discourse analysis of media presentation of prenatal screening in Iceland

Nuchal translucency (NT) screening has come to be widely used in antenatal care in many countries. In the capital area of Iceland, which is the focus of this study, 84% of pregnant women underwent screening in 2005. At the time no official policy had been formulated regarding the use of this screening, and very limited public discussion had taken place on the ethical issues related to its use. Although screening has been widely welcomed as a scientific and technological improvement, it may also have unintended consequences, both for practitioners and prospective parents, and for particular groups such as the disabled, which have not been fully explored. The purpose of this study was to examine how NT screening was introduced as a new practice and came to be adopted in prenatal care in Iceland. Using a genealogical approach, we explored the way in which the value and potential drawbacks of NT screening were presented to the public. The data used in the analysis comprised material published from the beginning of 2000 until the end of 2005, such as television programmes, newspaper and magazine articles and booklets written for prospective parents. The findings reveal that the screening was mainly promoted by staff at the specialized clinic where the test was offered, and that soon after its initiation screening became widespread. In interviews, both practitioners and parents of children with Down's syndrome questioned the eugenic implications of screening and its impact on the lives of the disabled and their relatives. However, the societal response was fairly muted and a critical debate regarding the routine use of NT screening can hardly be said to have taken place. These findings alert us to the importance of promoting critical discussion of new knowledge and technology in health care, particularly when serious ethical issues are involved.

The space in between: narratives of silence and genetic terminations

In North America, prenatal testing and genetic terminations are becoming clinically normalized. Yet despite this implied social acceptance, open discussions surrounding genetic terminations remain taboo and silenced. Women are socially isolated, their experiences kept secret, and their grief disenfranchised. The lack of social consensus regarding genetic terminations, the valorization of scientific knowledge, and the bioethical framing of the issue as a matter of personal choice and autonomy collectively serve to reify this silence. In many respects genetic screening offers a form of technological surveillance procuring security from the unwanted kind of child. Yet the manner in which 'the unwanted kind of child' is understood varies from context to context. While we carry with us the consequences of decisions made elsewhere, the institutionalized discourses upon which these decisions are made are not always so readily transportable. One must somehow reconcile 'the unwanted kind of child' of the biomedical model with 'the unwanted kind of child' who was to be a member of one's family. In this paper, my intention is not to engage in the broader debate surrounding prenatal testing and genetic terminations. Rather, I employ my clinical encounters with these practices to illustrate the absence of an ethical language that might do justice to the experiences such practices construct. The limitations of a bioethical discourse that remains abstracted from lived experience are discussed.