The medico-scientific expertise frame
This frame was predominant in our observations, articulating a moral
stance that supports the actors’ ability to make rational and autonomous
choices3,4 with a grid for understanding situations
based on the medico-scientific rationale at work in evidence-based
medicine. This is the frame that dominates the ‘therapeutic
modernity’.2 Practitioners are tasked with helping
women decide whether to continue with the investigations, and therefore
accept the risk of miscarriage when a sample is taken. This presupposes
that women have acquired sufficient expertise regarding the model for
calculating risks and interpreting their significance, and that
practitioners have provided clear information without engaging their own
subjectivity. The actions taking place within this frame thus
essentially involve providing/receiving/asking for scientific and
technical information relating to the nature of the risks, their value
and mode of calculation, how the medical acts are performed, and the
aetiology and consequences of the suspected pathologies.
All the consultations we observed began in the medico-scientific
expertise frame with the practitioner explaining the risk as being the
reason for the consultation. “I’m seeing you today to discuss the
results of the blood test. It allows us to evaluate the statistical risk
of having a child with Down Syndrome. Your risk is…” (Midwife,
France). Detailed technical information is then provided,
depending on the type of risk.
“It would appear that you have contracted a toxoplasmosis.
[…] The risk of transmission increases with the term. At the
beginning of the pregnancy it is 1%, at 9 months it is 80% of babies
who are contaminated. [but]the consequences are not the same. If it
is before 15 weeks, there can be serious consequences. Toxoplasmosis
attacks the entire organism but the most serious consequences are on the
brain” (Consultant, France).
Once the information on possible foetal anomalies has been given, the
practitioner provides details on the risk of miscarriage when a sample
is taken. The risk is frequently weighted by information on the
expertise of the operator, designed to reassure: