Exploring Physicians’ Views and Values in Relation to Maternal Serum Screening

Abstract

ObjectiveLittle is known about physician support for prenatal screening. We sought a better understanding of physicians’ values and opinions as they relate to prenatal screening, termination of affected pregnancies, and disability. MethodsSurveys were sent to all family physicians/general practitioners and obstetricians in Saskatchewan during May and June 2005. ResultsOf those physicians who responded, all obstetricians and 91% of family physicians reported offering maternal serum screening (MSS) to pregnant women in their practices. Of respondents who offered MSS to their patients, 87% of obstetricians and 72% of family physicians reported offering MSS to all pregnant women. Approximately one half of respondents agreed that they had enough knowledge to counsel a pregnant woman with a fetus affected by Down syndrome or spina bifida; 40% said the same about a fetus with trisomy 18. Twenty-six percent of physicians agreed that offering MSS was in conflict with their culture, religion, or personal value systems if it led to termination of pregnancy. One third of physicians reported having concerns about the increasing capacity for genetic testing of fetuses and the social, ethical, and clinical implications of such testing. ConclusionPhysicians held diverse views regarding prenatal screening, selective termination, and disability. Personal views and biases, in either direction, are relevant to our understanding of the clinical encounter and the ethical quandaries faced by practitioners. These value differences also may explain at least some of the variation in the use of MSS observed across the country, although the current study was not designed to make a causal link. There is a need to better understand how value differences affect the uptake of new reproductive technologies and the implications for health care policy and medical practice.