An ethics of reproductive choice : genetic counselling and prenatal diagnosis

For this project I describe the socio-historical development of a particularapplication of genetic prenatal diagnosis, in terms of changing social relationsthat govern an ethics of reproductive choice. I examine ways that medicine andgovernment articulate prenatal diagnosis to problematise the maternal body andgovern women's reproductive choices about chromosomal abnormality in thefetus.Since its introduction in the early 1970s, the major use of prenataldiagnosis has been to detect chromosomal abnormalities-in particular, Downsyndrome-in the fetus. Medico-scientific knowledge claims negotiated ineveryday practices in the genetic counselling clinic between health professionalsand their clients are situated within broader social relations. Negotiationsbetween medicine and government have produced technoscientific possibilities,realised with greater or lesser success in the co-construction of a workableprenatal diagnosis standardised package. I describe how these socio-technicalrelations have produced similarities and differences across time, and nationaland professional boundaries. My analysis draws on observations in three geneticcounselling clinics, and of the health professionals' other work activities. I alsodraw on interviews with them and other actors in that arena, as well as claimsmade about prenatal diagnosis technologies in the medico-scientific literature. Ianalyse my data using concepts developed in social worlds/arenas theory withina Foucauldian framework of social relations that govern the body.Since the early formation of a standardised package of genetic counsellingabout amniocentesis, ethical decisions about prenatal diagnosis have identified multiple parts of the self to be governed. This ethics has relied on a duty to makegenetically responsible decisions as a particular way to relate to oneself,although it has been expressed in different ways. Newer technologies havearticulated greater ethical possibilities for governing the self by co-constructingnew ways of assembling the constituent components. Throughout, there havebeen tensions between two major aims for governing the self: that of giving birthto a healthy baby, and that of managing maternal rationality in order to act as anautonomous rational individual. I have thus described how a woman's use ofprenatal diagnosis is not simply one of individual choice. Her decision is acomplex ethical one that is historically and socially contingent on relationsbetween medicine and government that present the maternal body in certainways for her to act upon herself