Ethics of routine: a critical analysis of the concept of ‘routinisation’ in prenatal screening

Journal of Medical Ethics 44 (9):626-631 (2018)

Abstract
In the debate surrounding the introduction of non-invasive prenatal testing in prenatal screening programmes, the concept of routinisation is often used to refer to concerns and potential negative consequences of the test. A literature analysis shows that routinisation has many different meanings, which can be distinguished in three major versions of the concept. Each of these versions comprises several inter-related fears and concerns regarding prenatal screening and particularly regarding NIPT in three areas: informed choice, freedom to choose and consequences for people with a disability. Three of the strongest arguments raised under the flag of routinisation are assessed for their validity: the threat that NIPT poses to informed choice, the potential increase in uptake of first-trimester prenatal screening and its consequences for social pressure to participate in screening or terminate affected pregnancies, and the negative consequences for disabled people. These routinisation arguments lack empirical or normative ground. However, the results of this analysis do not imply that no attention should be paid to possible problems surrounding the introduction of NIPT. At least two problems remain and should be addressed: there should be an ongoing debate about the requirements of informed choice, particularly related to an expanded scope of prenatal screening. Also, reproductive autonomy can only be achieved when expecting parents’ options are variegated, real and valuable, so that they can continue to choose whether or not to screen or to terminate a pregnancy.
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DOI 10.1136/medethics-2017-104729
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References found in this work BETA

The Morality of Freedom.Joseph Raz - 1986 - Philosophy 63 (243):119-122.
Direct-to-Consumer Genomics on the Scales of Autonomy.E. Vayena - 2015 - Journal of Medical Ethics 41 (4):310-314.
A Disability Critique of the New Prenatal Test for Down Syndrome.Chris Kaposy - 2013 - Kennedy Institute of Ethics Journal 23 (4):299-324.

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A New Era in Prenatal Testing: Are We Prepared? [REVIEW]Dagmar Schmitz - 2013 - Medicine, Health Care and Philosophy 16 (3):357-364.

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