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Book Review: The Ethics of Consent and Choice in Prenatal Screening

27 June 2011
Appeared in BioNews 613

The Ethics of Consent and Choice in Prenatal Screening

By Dr Eleanor Milligan

Published by Cambridge Scholars

ISBN-10: 1443826480, ISBN-13: 978-1443826488

Buy this book from Amazon UK

'The Ethics of Consent and Choice in Prenatal Screening' by Dr Eleanor Milligan

In this ambitious text, Eleanor Milligan peels back the ethical layers surrounding prenatal screening. She reveals a world in which women choosing if they should undergo prenatal screening are heavily influenced by social considerations and often demonstrate a lack of understanding about the technique. By exploring the many ethical factors which influence a woman's decision to undergo prenatal screening, Milligan highlights how many women who partake do so without truly giving their informed consent.

This book is important for future parents as it reveals some surprising statistics surrounding prenatal testing. It is also important for a wider audience as it questions how we view humanity and highlights our dangerous obsession with human perfection.

Although it is generally considered good ethical (and legal) practice to obtain informed consent before undergoing any type of medical intervention, Milligan questions whether ˈinformed consentˈ actually empowers patients to make the 'right' decision for themselves - or is it just a procedural exercise to satisfy the lawyers? Milligan discusses studies which have shown that women participating in prenatal screening often find it difficult to articulate its implications. Furthermore, women may feel compelled to submit to prenatal screening by the healthcare system itself.

Milligan argues the 'routinisation' of medical care often presumes active female participation and gives various examples of this written in the first person narrative. (This also allows the reader to gain a deeper insight into the woman's decision-making process). She therefore suggests that very often the consent a woman provides is - by default - not adequately informed, and the current system may on occasions undermine a woman's autonomy.

Milligan also considers the influence of social factors on women deciding whether to undergo prenatal screening. Should a mother take into account the impact of a disabled child on her family or society at large, for example? The negative perception of disability is considered as a choice limiting factor with regards to prenatal screening and such factors further undermine her ability to make an autonomous decision.

Such perceptions could make women feel compelled to accept prenatal screening, and without being acutely sensitive to the issue, healthcare staff could unwittingly encourage women into agreeing to it because of this 'fear' of human disability.

Milligan advocates 'patient education' as a crucial factor in the decision-making process to help ensure informed consent. Even with today's ease of access to information on the internet and an increasing tendency of people to actively seek information, she highlights how patient education in the clinical setting is still lacking.

The conclusion was clear - Milligan recommends a more patient-centred model for prenatal screening. It was, however, disappointing to not have seen more of the potential father's point of view. Aren't men also involved in the decision-making process?

Buy The Ethics of Consent and Choice in Prenatal Screening from Amazon UK.

9 May 2011 - by Dr Ainsley Newson 
As highlighted in BioNews, in early April 2011 the UK's Human Genetics Commission (HGC) published a report supporting preconception genetic testing and screening (1). Preconception screening, which can be broadly described as identifying carriers of genetic mutations to inform reproductive decision-making for the person tested or his/her relatives, is well established in some jurisdictions but relatively unknown in the UK...
13 October 2008 - by Lorna Stewart 
Scientists at Stanford University in California, US have developed a new non-invasive prenatal test for Down's syndrome. Stephen Quake and colleagues successfully identified presence and absence of fetal chromosomal abnormality in 18 pregnant women from maternal blood samples. The work is published this month in the journal...
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When the technology for testing IVF embryos for genetic mutations that cause disease was first developed over 15 years ago, its potential uses seemed pretty clear cut. Preimplantation genetic diagnosis (PGD) provided a way in which couples at high risk of having a child affected by a genetic disorder could...
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You can't draw and record a family tree without the permission of all the members shown on it - the Data Protection Act won't allow it''Medical confidentiality won't allow my laboratory to release a DNA result to allow genetic testing to be offered to another family member'.'You can't...
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