'Drawing the line' in prenatal screening and testing: health practitioners' discussions

As the number of fetal conditions which can potentially be screened and tested for rises, the question of whether limits should be set around prenatal screening is a timely one. There are many areas of disagreement as to whether a line can, or should be drawn, about what constitutes a 'severe' handicap, and about who should be involved in making such decisions. This paper reports on how health practitioners involved in prenatal screening discussed these questions in multidisciplinary groups facilitated by an ethicist. It explores the difficulties practitioners expressed about drawing lines on behalf of others, and then looks at who practitioners felt should be involved in drawing lines. Finally, using sex selection as an exemplar, the paper explores how practitioners discussed the possibility of selective terminations for fetal sex on social grounds. Although not impossible, it seems that reaching a public or professional agreement on prenatal screening policies will be difficult. With the current emphasis on informed choice, it is of paramount importance that there is no pressure to follow a particular line of action. This must rely in part on the provision of accurate information devised and conveyed by practitioners and people with broad, practical experience of conditions being screened for.