The provocative essays in this volume respond to Foucault's call to question what is regarded as natural, inevitable, ethical, and liberating, while they ...

Prenatal care and the practice of prenatal genetic testing are about to be changed fundamentally. Due to several ground-breaking technological developments prenatal screening and diagnosis (PND) will soon be offered earlier in gestation, with less procedure-related risks and for a profoundly enlarged variety of targets. In this paper it is argued that the existing normative framework for prenatal screening and diagnosis cannot answer adequately to these new developments. In concentrating on issues of informed consent and the reproductive autonomy of the (...) pregnant women the ethical debate misses problems related to the clinical pathway as a whole and to implicit normative attributions to clinical actions or the function of health care professionals. If, however, ethical debate would focus on the clinical context and on the ends of PND to a larger extent, it would be able to provide a more comprehensive analysis of the ethical challenges especially of the new technologies in order to be more adequately prepared for their implementation. (shrink)

Sequenom Inc., a developer of medical diagnostic products, recently made their noninvasive test for Down syndrome available for clinical practice.1 The DNA-based test—given the name “MaterniT21”—requires only a simple maternal blood sample as early as 10 weeks of gestation. In recent clinical trials involving thousands of pregnant women, the MaterniT21 test identified 99.1% of cases of Down syndrome, and gave the correct result in 99.9% of cases when the fetus did not have Down syndrome. Sequenom’s test is thought to be (...) an improvement on previous prenatal testing techniques because of its. (shrink)

Recent scientific advances mean the widespread introduction of non-invasive prenatal diagnosis (NIPD) for chromosomal aneuploidies may be close at hand, raising the question of how NIPD should be introduced as part of antenatal care pathways for pregnant women. In this paper, the authors examine the ethical implications of three hypothetical models for using NIPD for aneuploidy in state-funded healthcare systems and assess which model is ethically preferable. In comparing the models, the authors consider their respective timings; how each model would (...) fit with current screening and diagnostic tests offered to pregnant women; the implications of offering NIPD at different stages of pregnancy; and the potential for each model to support reproductive autonomy and informed decision-making. The authors conclude by favouring a model that would be offered at 11–13 weeks gestation, alongside existing combined screening, provided that this is accompanied by measures to maximise informed decision-making, for example, provision of adequate pretest and post-test counselling. (shrink)

The social shaping of technology (SST) approach to analysing technological development lends itself to an understanding of the relatively negotiated, heterogeneous, and local character of technologies, politicising the mediated nature of sociotechnical change. Here, conditions of actor engagement lie at the heart of analysing technology in social context—that is, the occasions, strategies, and scope of influence that are afforded different actors, by way of how particular problems come to be defined and resolved. In this paper we examine the framing of (...) a number of concrete technology assessments (TAs) from Denmark, from the realms of general TA and health technology assessment (HTA). Our examination of the TA initiatives is directed towards the relatively open-ended and consequently explorative and qualitative stance that SST takes in characterising the boundaries between the technical and the social. The paper goes on to discuss a possible place of ethical inquiry in TA, based on the understanding of technological development that SST affords. In the reflexive approach to addressing technology's relation to society, technology no longer maintains a universally reducible character in time or in social space. Through the possibility of analytically and practically opening up for otherwise seemingly locked actor-positions SST gives room for a more differentiated questioning and treatment of ethical issues in which technology may be implicated. (shrink)