Medicine, Health Care and Philosophy

, Volume 14, Issue 1, pp 53–61 | Cite as

Bioethical concepts in theory and practice: an exploratory study of prenatal screening in Iceland

Scientific Contribution


A hallmark of good antenatal care is to respect prospective parent’s choices and provide information in a way that encourages their autonomy and informed decision making. In this paper, we analyse the meaning of autonomous and informed decision making from the theoretical perspective and attempt to show how those concepts are described among prospective parents in early pregnancy and in the public media in a society where NT screening is almost a norm. We use interviews with Icelandic prospective parents in early pregnancy (N = 40) and material covering the discourse around prenatal screening in the media over 5 years period. Our analysis indicates that both prospective parents and the public media include ethical terms in their rhetoric around prenatal screening although those concepts differ in their expression. We conclude that the context in which these decisions are taken does not encourage moral reflection. Prospective parents describe that there is a lack of dialogue with professionals when decisions are made about screening. With routine offer of screening the conceptualization of bioethical concepts finds its own way through a mainstream discourse which has limited connections to the theoretical notions. This has been neglected in the implementation of screening, as limited effort has been subject to audit with reference to explore how the offer of screening and informed choice is experienced among prospective parents.


Fetal screening Autonomy Informed decision Prospective parents Ethics Experience 


  1. Alderson, P. 2001. Prenatal screening, ethics and Down’s syndrome: A literature review. Nursing Ethics 8(4): 360–374.PubMedGoogle Scholar
  2. Árnason, V. 1994. Towards authentic conversations. Authenticity in the patient-professional relationship. Theoretical Medicine 15: 227–242.CrossRefPubMedGoogle Scholar
  3. Árnason, V. 2000. Gadamerian dialogue in the patient-professional interaction”. Medicine, Health Care and Philosophy 3: 17–23.CrossRefGoogle Scholar
  4. Beauchamp, T.L., and J.F. Childress. 2001. Principles of biomedical ethics, 5th ed. New York: Oxford University Press.Google Scholar
  5. Chadwick, R. 1999. Genetics, choice and responsibility. Health, Risk & Society 1: 293–299.CrossRefGoogle Scholar
  6. Chervenak, F.A., L. McCullough, and S. Chasen. 2005. Clinical implications of the ethics of informed consent for first-trimester risk assessment for trisomy 21. Seminars in Perinatology 29(4): 277–279.CrossRefPubMedGoogle Scholar
  7. Coulter, A. 2006. Trends in patients experience of the NHS. Oxford: Picker Institute Europe.Google Scholar
  8. Coulter, A., and J. Ellins. 2007. Effectiveness of strategies for informing, educating, and involving patients. BMJ 335(7609): 24–27.CrossRefPubMedGoogle Scholar
  9. di Gregorio, S. 2003. Teaching grounded theory with QSR NVivo. Qualitative Research Journal 3: 79–95.CrossRefGoogle Scholar
  10. Directorate of Health. 2006. Medgönguvernd heilbrigdra kvenna í edlilegri medgöngu. Klíniskar leiðbeiningar [Antenatal care in normal pregnancy. Clinical guidelines]. Retrieved 11 Jan.
  11. Dworkin, G. 1988. The theory and practice of autonomy. Cambridge: Cambridge University Press.CrossRefGoogle Scholar
  12. Foucault, M. 1980. Power/knowledge: Selected interviews and other writings 1972–1977. New York: Pantheon Books.Google Scholar
  13. Fraser, N., and L. Gordon. 1994. A genealogy of dependency: Tracing a keyword of the U.S. welfare state. Signs 19(2): 309–336.CrossRefGoogle Scholar
  14. Garcia, Timmermann, and E. van Leeuwen. 2008. The impact of ethical beliefs on decisions about prenatal screening tests: Searching for justification. Social Science and Medicine 66(3): 753–764.CrossRefPubMedGoogle Scholar
  15. Gottfreðsdóttir, H., and K. Björnsdóttir. 2010. Have you had the test? A discourse analysis of media presentation of prenatal screening in Iceland. Scandinavian Journal of Caring Sciences 24 (in press).Google Scholar
  16. Gottfreðsdóttir, H., J. Sandall, and K. Björnsdóttir. 2009. This is just what you do when you are pregnant: A qualitative study of prospective parents in Iceland who accept nuchal translucency screening. Midwifery 25: 711–720.CrossRefGoogle Scholar
  17. Gourounti, K., and J. Sandall. 2008. Do pregnant women in Greece make informed choices about antenatal screening for Down’s syndrome? A questionnaire survey. Midwifery 24: 153–162.CrossRefPubMedGoogle Scholar
  18. Hasman, A., A. Coulter, and J. Askham. 2006. Education for partnership: Developments in medical education. Oxford: Picker Institute Europe. Also available from
  19. Hjörleifsson, S., V. Árnason, and E. Schei. 2008. Decoding the genetics debate: Hype and hope in Icelandic news media 2000 and 2004. New Genetics and Society 27(4): 377–394.CrossRefGoogle Scholar
  20. Katz, J. 1984. The silent world of doctor and patient. New York: The Free Press.Google Scholar
  21. Kerr, A. 2004. Genetics and society: A sociology of disease. London: Routledge.Google Scholar
  22. Kristinsson, S., and V. Árnason. 2007. Informed consent and human genetic database research. In The ethics and governance of human genetic databases. European perspectives, ed. M. Häyry, R. Chadwick, V. Árnason, and G. Árnason, 199–216. Cambridge, New York: Cambridge University Press.CrossRefGoogle Scholar
  23. Kvale, S. 1996. Interviews: An introduction to qualitative research interviewing. London: Sage Publications.Google Scholar
  24. Marteau, T., and E. Dormandy. 2001. Facilitating informed choice in prenatal testing: How well are we doing? American Journal of Medical Genetics 106: 185–190.CrossRefPubMedGoogle Scholar
  25. McLeod, C. 2002. Self-trust and reproductive autonomy. Cambridge, MA: The MIT Press.Google Scholar
  26. National Institute for Health and Clinical Excellence [NICE]. 2008. NICE clinical guideline 62. Antenatal care: Routine care for the healthy pregnant woman. London: Author. Retrieved 10 April 2008 from
  27. Nicholaides, K. 2004. Nuchal translucency and other first trimester sonographic markers of chromosomal abnormalities. American Journal of Obstetrics and Gynecology 191: 45–67.CrossRefGoogle Scholar
  28. Nicol, M. 2007. Vulnerability of first-time expectant mothers during ultrasound scans: An evaluation of the external pressures that influence the process of informed choice. Health Care for Women International 28: 525–533.CrossRefPubMedGoogle Scholar
  29. Pálsson, G., and K.E. Hardardóttir. 2002. For whom the cell tolls: Debates about biomedicine. Currents Anthropology 43(2): 271–287.CrossRefGoogle Scholar
  30. Petersen, A., and R. Bunton. 2002. The new genetics and the public’s health. London: Routledge.Google Scholar
  31. Pilnick, A. 2008. It’s something for you both to think about: Choice and decision making in nuchal translucency screening for Down’s syndrome. Sociology of Health & Illness 30(4): 511–530.CrossRefGoogle Scholar
  32. Rapp, R. 2000. Testing the women, testing the fetus. New York: Routledge.Google Scholar
  33. Regulation on Health Care Centres no. 787/2007. [Reglugerð um heilsugæslustöðvar nr. 787/2007].Google Scholar
  34. Rentmeester, C. 2001. Value neutrality in genetic counselling: An unattained ideal. Medicine, Health Care and Philosophy 41: 47–51.CrossRefGoogle Scholar
  35. Ritchie, J., and J. Lewis. 2003. Qualitative research practice: A guide for social science students and researchers. London: Sage Publications.Google Scholar
  36. Silverman, D. 2006. Interpreting qualitative data. London: Sage Publications.Google Scholar
  37. Smeenk, A., and H.A.M.J. ten Have. 2003. Medicalization and obstetric care: An analysis of development in Dutch midwifery. Medicine, Health Care and Philosophy 6: 153–165.CrossRefGoogle Scholar
  38. Smith, S. 1981. Three models of the nurse-patient relationship. In Biomedical ethics, ed. T.A. Mappes, and J.S. Zembaty, 120–126. New York: McGraw-Hill.Google Scholar
  39. Suter, S.M. 2002. The routinization of prenatal testing. American Journal of Law and Medicine 28: 233–270.PubMedGoogle Scholar
  40. Van Teijlingen, E.R., v. Hundley, A.M. Rennie, et al. 2003. Maternity satisfaction studies and their limitations: What is must still be best. Birth 30: 75–82.CrossRefPubMedGoogle Scholar
  41. Veatch, R.M. 1981. Models for ethical medicine in a revolutionary age. In Biomedical ethics, ed. T.A. Mappes, and J.S. Zembaty, 56–59. New York: McGraw-Hill.Google Scholar
  42. Williams, C. 2005. Framing the foetus in medical work: Rituals and practices. Social Science and Medicine 60(9): 2085–2095.CrossRefPubMedGoogle Scholar
  43. Williams, C., P. Alderson, and B. Farsides. 2002. Is nondirectiveness possible within the context of antenatal screening and testing? Social Science and Medicine 54: 17–25.Google Scholar
  44. Williams, C., J. Sandall, G. Lewando-Hundt, R. Grellier, B. Heyman, and K. Spencer. 2005. Women as ‘moral pioneers’? Experiences of first trimester nuchal translucency screening. Social Science and Medicine 61(9): 1983–1992.CrossRefPubMedGoogle Scholar
  45. Zeiler, K. 2004. Reproductive autonomous choice—A cherished illusion? Reproductive autonomy examined in the context of preimplantation genetic diagnosis. Medicine, Health Care and Philosophy 7: 175–183.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2010

Authors and Affiliations

  1. 1.Department of Midwifery, Faculty of NursingUniversity of IcelandReykjavíkIceland
  2. 2.Department of Philosophy & Centre for EthicsUniversity of IcelandReykjavíkIceland

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