Too many choices? Hospital and community staff reflect on the future of prenatal screening.

Promoting informed choice is commonly recognised as the chief purpose and benefit of prenatal screening, its very presence being viewed as a key way in which the process can be distanced from eugenics. As the number of conditions and features which can potentially be screened for rises, dilemmas about how to achieve informed choice can only increase. Seventy hospital and community staff working in or attached to two English hospitals were interviewed individually on topics which included their views on genetic developments and moral beliefs and values, and how these affected their daily work. The majority then took part in small discussion groups led by an ethicist. The research identified a paradox. On the one hand, participants recognised the centrality of informed choice to prenatal screening, although they had many doubts about whether it could be achieved. On the other hand, most saw the expansion of screening, which might further compromise informed choice, as an inevitable and inexorable process over which they had little, if any, control. This was despite the fact that many of them decided, managed or implemented prenatal screening policies within their hospitals. The paper explores the factors which staff themselves identified as responsible for this perceived inevitable expansion. It then discusses more generally how the expansion of medical technologies can appear as inexorable to those involved. Finally, the paper calls for more inclusive, integrated and collaborative debate and research around the whole area of prenatal screening. This is to ensure that as far as possible, the wider consequences and implications of any proposed expansion to prenatal screening-both the promises and the potential side-effects-are debated ahead of their implementation, and also to help ensure that public policy represents and serves contemporary society.