Is nondirectiveness possible within the context of antenatal screening and testing?

被引:94
作者
Williams, C
Alderson, P
Farsides, B
机构
[1] Univ London, Social Sci Res Unit, London WC1H 0NS, England
[2] Kings Coll London, Ctr Med Law & Eth, London WC2R 2LS, England
基金
英国惠康基金;
关键词
prenatal screening; nondirective counselling; genetic risks; genetic counselling;
D O I
10.1016/S0277-9536(01)00032-6
中图分类号
R1 [预防医学、卫生学];
学科分类号
1004 ; 120402 ;
摘要
Partly in order to dissociate itself from eugenics, genetic counselling values the principle of nondirectiveness as a key feature. Recent reports have upheld the importance of this approach, treating it unproblematically. However, doubts have been expressed about whether nondirective counselling is possible or indeed, desirable. Changes in organisational aspects of antenatal screening delivery in the UK have meant that genetic counselling is now being carried out by a variety of practitioners other than counsellors and specialists. These are often practitioners such as obstetricians and midwives who, in many other aspects of their work do not practise in a nondirective way. This paper explores some of the difficulties health practitioners encountered when attempting to work nondirectively. Reasons given by practitioners for not following this approach fell into categories, which in turn formed a continuum. Categories along the continuum ranged from acting directively at the request of women, through to deciding for women. either covertly or overtly, in their "best interests". It appears that for practitioners, the boundary between choice and coercion is not a clearcut one, and visualising it instead as a continuum may make it easier to see how slippage between choice and coercion can occur. The paper highlights the dilemmas which a variety of practitioners are dealing with in their daily work, in the hope of encouraging debate about these complex clinical and ethical issues. (C) 2002 Elsevier Science Ltd. All rights reserved.
引用
收藏
页码:339 / 347
页数:9
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