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Title: Difficult decisions : autonomy, prenatal choice and prognostic ambiguity
Author: Leonard, Samantha Jane
ISNI:       0000 0004 5917 1357
Awarding Body: University of Bristol
Current Institution: University of Bristol
Date of Award: 2014
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New methods of fetal anomaly detection will offer increasingly detailed information to prospective parents but are likely to lead to more frequent discovery of anomalies with an ambiguous prognosis for the future child. It is important to consider the ethical implications of such ambiguity prior to introducing new tests. An examination of the bioethics literature reveals 'promoting autonomy' as the predominant justification for fetal anomaly detection. Two questions arise: does the fetal anomaly detection programme as it stands promote autonomy, and is 'promoting autonomy' an appropriate ethical principle in this context? To answer these questions, an empirical bioethics approach using a reflexive balancing methodology is employed. This examines qualitative data from interviews of prospective parents who had had to decide, on the basis of such an ambiguous prognosis, whether or not to continue their pregnancy. On the basis of different accounts of autonomy, it is argued that the fetal anomaly detection programme does not promote autonomy when decisions are based on an uncertain prognosis. Moreover, 'promoting autonomy' is not, on its own, an appropriate aim in this setting, as the participants did not use their choice as a means of self-expression, the decisions were made by two people and were heavily swayed by considerations for the future child, and under conditions of uncertainty it is not possible to attain the level of rational decision-making required by most accounts of autonomy. Furthermore, the impacts of the decision reduce the benefit of any potential opportunity for self-expression through these choices. The data indicated that a welfare approach might be more appropriate, and it was concluded that, whilst a welfare approach did not entirely encompass all of the nuances of the participants' experiences, it was the better fit, giving some useful indications for an ethical framework for an expanded offer of testing.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available