Introduction
Pregnancy-related genetic counselling has developed significantly since
the 1970s and the liberalisation of abortion. Eager to dissociate
themselves from eugenic practices, practitioners placed women’s
decision-making autonomy at the centre of their work.1This orientation is more broadly embedded in the international context
of the rise of bioethics, of women’s and disability movements and of the
shift over to the ‘therapeutic modernity’ model, characterised by more
standardised healthcare practices, regulated away from the
doctor-patient relationship by central bodies that articulate
evidence-based medicine with a procedural and “juridicised” vision of
ethics. 2,3
In this context, the concept of autonomy is based on a Western, modern
conception of individuals as rationale beings.4 It
goes hand-in-hand with the principle of “non-directiveness” that is
now an integral part of the prenatal diagnosis (PND)
guidelines.5
In the field of PND, the choice between two risks – that of a child
being born with an impairment, versus that of the loss of a healthy
child following amniocentesis – has strongly influenced the way
pregnancy is monitored. The generalisation of antenatal screening and of
increasingly effective imaging techniques now makes it possible to
identify “high-risk pregnancies” and detect a large number of
anomalies, whilst limiting the loss of healthy foetuses.