Beyond easy answers: prenatal diagnosis and counseling during pregnancy.
OBJECTIVE
The advancing sophistication and availability of prenatal diagnostic technologies, such as transvaginal ultrasound, chorionic villus sampling, amniocentesis, and alpha feto-protein testing, have increased the medical capacity to detect genetic and congenital conditions during pregnancy. This paper raises many social and ethical questions about how families, craniofacial teams, and society respond when a prenatal diagnosis is made and considers the ethical and social issues around counseling, managing information, and making decisions.


METHODS
Ethical and sociological analysis.


METHODS
Implications examined on the societal, health professional, and family level.


RESULTS
Families and health professionals often manage ambiguity, uncertainty, and complex decision making in facing a prenatal diagnosis. Embedded in parental and clinical decisions are values about children with birth defects. Families are making decisions about whether to bear or abort an affected fetus on the basis of their perceptions of the impairment and on their expectation of the burden involved for the family and the child. On a broader, societal level, pressures to conform and minimize human differences are apparent in biomedical interventions, the Human Genome Project, advertising and media images, and social pressures to normalize disabilities. How society deals with prenatal diagnosis will impact upon social values; moral, legal, and ethical perspectives; and on health policy.


CONCLUSIONS
Prenatal diagnostic technologies raise complex ethical, family, policy, and legal issues that have broad implications for the lives of children born with special health care needs, including children with cleft lip and palate.
Strauss
Ronald P
RP
Department of Dental Ecology, University of North Carolina School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599-7450, USA. Ron_Strauss@unc.edu.
D000028:Abortion, Induced; D002971:Cleft Lip / Q000175:diagnosis; D002972:Cleft Palate / Q000175:diagnosis; D000013:Congenital Abnormalities / Q000175:diagnosis; D003376:Counseling; D003657:Decision Making; D004989:Ethics; D005195:Family Relations; D005260:Female; D005315:Fetal Diseases / Q000175:diagnosis; D030342:Genetic Diseases, Inborn / Q000175:diagnosis; D006291:Health Policy; D006801:Humans; D009014:Morals; D011247:Pregnancy; D011256:Pregnancy Outcome; D011296:Prenatal Diagnosis; D011368:Professional-Family Relations; D012931:Social Environment; D012945:Social Values; D015974:Wrongful Life