An ethics of reproductive choice : genetic counselling and prenatal diagnosis

Abstract

For this project I describe the socio-historical development of a particular application of genetic prenatal diagnosis, in terms of changing social relations that govern an ethics of reproductive choice. I examine ways that medicine and government articulate prenatal diagnosis to problematise the maternal body and govern women's reproductive choices about chromosomal abnormality in the fetus. Since its introduction in the early 1970s, the major use of prenatal diagnosis has been to detect chromosomal abnormalities-in particular, Down syndrome-in the fetus. Medico-scientific knowledge claims negotiated in everyday practices in the genetic counselling clinic between health professionals and their clients are situated within broader social relations. Negotiations between medicine and government have produced technoscientific possibilities, realised with greater or lesser success in the co-construction of a workable prenatal diagnosis standardised package. I describe how these socio-technical relations have produced similarities and differences across time, and national and professional boundaries. My analysis draws on observations in three genetic counselling clinics, and of the health professionals' other work activities. I also draw on interviews with them and other actors in that arena, as well as claims made about prenatal diagnosis technologies in the medico-scientific literature. I analyse my data using concepts developed in social worlds/arenas theory within a Foucauldian framework of social relations that govern the body. Since the early formation of a standardised package of genetic counselling about amniocentesis, ethical decisions about prenatal diagnosis have identified multiple parts of the self to be governed. This ethics has relied on a duty to make genetically responsible decisions as a particular way to relate to oneself, although it has been expressed in different ways. Newer technologies have articulated greater ethical possibilities for governing the self by co-constructing new ways of assembling the constituent components. Throughout, there have been tensions between two major aims for governing the self: that of giving birth to a healthy baby, and that of managing maternal rationality in order to act as an autonomous rational individual. I have thus described how a woman's use of prenatal diagnosis is not simply one of individual choice. Her decision is a complex ethical one that is historically and socially contingent on relations between medicine and government that present the maternal body in certain ways for her to act upon herself.