Ethical practice in prenatal screening - can informed consent deliver?

Abstract

As the technological capacity to diagnose certain conditions prenatally expands, and more asymptomatic women are exposed to routine forms of prenatal screening, increasing emphasis is being placed on the garnering of informed consent within existing testing regimes to confer ethical legitimisation to this routine medical intervention. But while the garnering of informed consent has been incorporated into prenatal routines, recent studies show that for most women the purpose, practicalities and potential outcomes of the tests they have 'consented' to are poorly understood. Indeed most have simply followed the prescribed normative pathway without question. These findings contradict assertions of 'informed' engagement and thus cast doubt on the ethical validity of the currently accepted protocols. Closer consideration of the underlying assumptions of autonomy, on which informed consent is based reveals that the individualistic notions embedded do not reflect the rational way in which people interact. When applied in a context that offers few educational opportunities to become truly informed and which is unresponsive to the social, institutional and personal constraints experienced, the mere layering of 'informed consent' onto existing, unchallenged regimes is failing to achieve ethically coherent outcomes. Clearly, the current situation is proving to be an inadequate platform from which to build ethically sensitive responses to the complex ethical issues at stake in an increasingly technological world. With recent history of antenatal care showing how quickly new technologies are embraced often before their clinical or societal implications are clear, ensuring ethically responsive practices into the 21st century demands further consideration now, with a re-thinking of howgenuinely informed consent may be achieved.