Towards Responsible Management of Prenatal Diagnosis: Arguments for and against

Abstract

These bioethical reflections review the comparative arguments surrounding specific responsibilities raised by prenatal diagnosis: i) in the face of a risk pregnancy, attested by precise medical documentation, should recourse to prenatal diagnosis figure as a moral obligation or, conversely, is unconditional acceptance of the child incompatible with all prior “quality control”? (parental responsibility) ii) if so, does the final decision rest with the parents, and is a completely neutral attitude by the doctor justified even when the foetus has a complaint for which adequate forms of treatment are available? (medical and professional responsibility) iii) is it right to promote health campaigns introducing compulsory screening for risk categories with the prospect of automatically selecting out foetuses bearing genetic anomalies? (social responsibility). After analysis and discussion of the conflicting arguments over responsible management of prenatal diagnosis, there is a review of the stages through which the diagnostic process passes when a couple go for prenatal diagnosis under the shadow of a risk pregnancy. The aim is to assess the role that may be played by specific ethically-oriented support within the counselling process. For such support to be properly framed, the following suggestions are made: i) Helping towards an aware decision: the consultant should help the couple take a sufficient distance from the outside world and face up to the situation in personal terms. They must be able to decide by criteria they see as their own, worked out as a couple and not absorbed from outside (which mostly means ratified by hearsay). As part of helping the couple to an authentic decision, one notes the concern not to reduce prenatal diagnosis to an automatic stage in a medical routine. Being referred for diagnosis by one's G.P. does not dispense with the need for the parents involved in the first person to size up the position for themselves. ii) Helping to pinpoint the responsibilities that can in all conscience be shouldered: amid the ambivalence that most couples experience, it is important that some outsider should let them know the difficulties that await them, but also the resources they can draw on. Though it is up to the couple to decide whether to terminate or go on with the pregnancy, the process of talking, confiding, reflecting and judging nonetheless gives its own weight of humanity to the decision that will come of it. At the same time it creates the right space in which to identify the real responsibility that one can in all conscience take upon oneself; iii) Creating the conditions for authentic ethical discernment: prenatal diagnosis puts the couple in a paradoxical situation precisely because every pregnancy lives in the hope of a child as its achievement and outcome; the handicap that one learns of through prenatal diagnosis just when the investment is at its ideal height may prove to be something truly intolerable. There are two particular ways of imaging the “blow” of a positive outcome which strongly condition the ethical discernment or even make it impossible: seeing it as an “error”; seeing it as a “horror”. The real alternative to these lies in configuring limitation and impairment as an integral part of our human condition, through which discerning attitude one can come to identify with the handicapped child and recognise the right it has to lead “its own” life.