1. Challenging the Rhetoric of Choice in Prenatal Screening
Victoria Seavilleklein

2. 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.
Seavilleklein’s thesis: Screening does not prtet or promote women’s autonomy in most cases (on various notions of autonomy).

3. 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.

4. 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.

5. 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.

6. 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.

7. 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.

8. A relational view
Women’s actual choices and options vs. the ones medical profession allows.
E.g., Abortion OK at 20 weeks for Down’s Syndrome, but not sex selection.
Social supports for various decisions – e.g., to give birth to a baby with severe disabilities.

9. Conclusion NOT opposed to pre natal screening.
But wants us to think more deeply about women’s 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.