“Simply providing information”: Negotiating the ethical dilemmas of obstetric ultrasound, prenatal testing and selective termination of pregnancy

Abstract

Obstetric ultrasound is key to opposing ways of valuing foetuses, that is, both to the ascription of foetal personhood and to foetal selection and termination of pregnancy. Whilst ultrasound images are increasingly common within the public sphere there has been relatively little public discussion of its role in identifying actual or potential foetal anomaly and the consequences of this. This paper examines how professionals working with obstetric ultrasound encounter, navigate and make sense of the different uses of this technology. Professionals commonly delineate their work (as providing information) from women’s autonomous choices. Emphasising “women’s choice” can obscure consideration of different collective ways of valuing foetuses with anomalies. It can also deflect consideration of the fundamentally ambiguous information that ultrasound can produce. Distinguishing information from choice is underpinned by a questionable fact–value distinction. We describe alternate professional practices which involve questioning these binaries and foregrounding clinicians’ responsibilities for women’s current and future experience. Public discussion of ultrasound’s different roles in valuing foetuses would be enriched if the discourses and practices shaping professionals’ attempts to facilitate ethical decision-making were included for collective consideration.

Navigating the uncertainties of screening: the contribution of social theory

“…The way we communicate with people about screening is, at least in theory, changing (Hersch, Jansen et al 2016) but informed choice must be based on adequate knowledge, which may or may not be present (Ward, Coffey et al 2015). As Stephenson et al (2017) have argued in the context of antenatal screening, "distinguishing information from choice is underpinned by a questionable factvalue distinction". As discussed earlier, evaluating a screening programme's effectiveness can be challenging, especially in the absence of high quality trial data.…”

First and second trimester ultrasound in pregnancy: A systematic review and metasynthesis of the views and experiences of pregnant women, partners, and health workers

“…Some feared the potential for consequences for both the mother, and for their professional security, if abnormalities were missed [ 36 , 39 , 76 ]. In some LMIC contexts, concerns were also expressed about the lack of appropriate training and the potential for this to result in missed complications or misdiagnosis [ 38 , 39 , 76 , 80 ]. Some respondents described professional and moral dilemmas around prioritising either mother or fetus in their clinical assessments [ 35 , 40 , 81 , 82 ], as well ethical concerns when parents made decisions that did not fit with personal or professional beliefs [ 55 , 80 , 82 ].…”

“…In some LMIC contexts, concerns were also expressed about the lack of appropriate training and the potential for this to result in missed complications or misdiagnosis [ 38 , 39 , 76 , 80 ]. Some respondents described professional and moral dilemmas around prioritising either mother or fetus in their clinical assessments [ 35 , 40 , 81 , 82 ], as well ethical concerns when parents made decisions that did not fit with personal or professional beliefs [ 55 , 80 , 82 ]. Some also expressed concern that women would go to any lengths to protect the wellbeing of their baby, even when this was to their own detriment [ 38 , 75 , 81 ].…”

“…For some, it also offered the potential for choice and the opportunity to plan when complications were detected [ 22 , 68 , 84 , 85 ]. However, for many, the identification of abnormalities was completely unexpected [ 17 , 18 , 20 , 24 , 65 , 69 , 73 , 80 , 86 – 88 ]. Some reported deep shock and distress on hearing this news [ 17 , 65 , 67 , 69 , 73 , 86 – 89 ].…”

“…Women and partners expressed a desire for scan providers to recognise the unique nature of the scan experience for them, to make them feel welcome, and to provide information and the opportunity to ask questions [ 21 , 22 , 25 , 76 , 65 , 88 ]. Their actual experiences ranged from health workers being cold, disinterested, and lacking time to provide information, to those who were warm and engaging, and actively fostered questions and interest in the scan [ 18 , 19 , 22 , 72 , 80 , 92 ]. In some contexts, women reported that they were unable to ask questions and that their experience was completely in the hands of the healthcare professional [ 19 , 92 ].…”