Inescapable Decisions

Abstract

The main ethical principle in prenatal testing is the autonomous decision of the pregnant woman concerned. However, recent developments in prenatal testing undermine this model. The overall number of invasive prenatal examinations has dropped significantly. Yet, the amount of pathologic results has increased. Due to the improvement in ultrasound diagnostics the predictability of possible disabilities or diseases of the unborn child has increased substantially. As a result of this pregnant women can take the decision whether or not to undergo invasive prenatal examinations on the basis of personal risk "evidence" produced earlier on by means of non-invasive screening. It can be questioned, how autonomous decisions can be if they are increasingly pre-informed through upstream riskassessments on the basis of non-invasive screening. Particularly ultrasound screening is often carried out without thorough counselling and sometimes even without consent. The concept of autonomy is difficult to uphold if women do not deliberately decide whether to undergo non-invasive screening, but the moment of such a deliberate decision comes only after positive screening results. Taking into account that public discourses have rather focused on other aspects of genetic or reproductive technologies such as stem cell research or pre-implantation diagnosis it is important to analyse how technological innovations transform medical practices without a re-articulation on a discursive level as I will try to show in this paper for the case of prenatal testing.