The ethics of antenatal screening: lessons from Canute.

Modern medicine has given us the power to identify many diseases before they occur and apply preventative measures so that morbidity and mortality may be avoided. When these screening measures are offered to someone who is capable of making an informed decision to proceed, they may be uncontroversial but may actually cause more harm than good. In antenatal screening, it is difficult to define who the patient is, because there are several possibilities: the pregnant woman, the foetus, or the family. Consequently, it can be difficult to identify whether the treatment offered is in the best interest of all concerned. Our growing knowledge about the human genome will in future give us more power to be able to identify undesirable traits, but there is no strict definition where the line of acceptability lies. The eugenic excesses of the mid-20(th) century are often cited as a reason why antenatal screening is bad. The story of King Canute informs us that defining a 'line in the sand' cannot prevent the rising tide of medical capability overwhelming any arbitrary level of acceptability. This paper discusses the history of eugenics from Sparta to the modern day and attempts to give some perspective on this crucial policy area. No one paper can provide the answer: it is necessary that society as a whole debates where it wishes to go...