Enhancing ethical practice in prenatal screening : facilitating women's ethical choices

Milligan, Eleanor (2008) Enhancing ethical practice in prenatal screening : facilitating women's ethical choices. PhD thesis, Queensland University of Technology.


Informed consent, based on patient autonomy, is seen as necessary if medical interventions are to be seen as legally and ethically acceptable. While 'informed consent' protocols within antenatal care, including prenatal screening regimes are presumed to be robust, emerging research outside of Australia suggests most women do not adequately understand the medical purpose, limitations or potential ethical implications, such as selective termination, of the medical procedures 'consented' to. While the consent given in these situations may well fulfil the minimal legal criteria for informed consent, the required level of knowledge and understanding necessary to meet the ethical standards informed or understood consent often appears not be met. The presumption that legally informed consent equates to morally informed consent inherent within institutional protocols for screening must therefore be questioned, and the ethical integrity of these increasingly routine interventions demand further scrutiny.

The purpose of this research was to explore whether the problems identified in research overseas might also exist locally. Underpinned by a phenomenological philosophical approach to understanding the ethical dimensions of clinical practice, the research sought to engage with a small cohort of mothers and practitioners locally. The study adopted a qualitative narrative methodology, analysing individual in-depth interviews using the Listening Guide (Gilligan et al, 2003). The experiences of mothers and health practitioners interviewed exposed a range of institutional, social, personal and philosophical constraints that mirrored the overseas research findings and also illuminated how informed consent may be unintentionally undermined in the clinical setting.

A positive outcome of the study was that it provided a locally informed and contextually sensitive basis from which to strengthen existing organisational informed consent protocols and thus support women's ethical decision making. As the process of becoming 'informed' to consent is largely educational, promoting patient learning in the clinical context is an ethical imperative. However, there seems limited awareness at either the clinical or theoretical level of the critical link between patient education and ethically robust medical intervention. Hence a significant contribution of this research was to explore this underdeveloped but practically important link.

As the process of gaining informed consent has far reaching applications across a broad spectrum of medical interventions, the contextual and educational insights offered throughout this research may have significant relevance beyond the immediate context of this research.

Impact and interest:

Citation counts are sourced monthly from Scopus and Web of Science® citation databases.

These databases contain citations from different subsets of available publications and different time periods and thus the citation count from each is usually different. Some works are not in either database and no count is displayed. Scopus includes citations from articles published in 1996 onwards, and Web of Science® generally from 1980 onwards.

Citations counts from the Google Scholar™ indexing service can be viewed at the linked Google Scholar™ search.

Full-text downloads:

1,496 since deposited on 12 Feb 2009
92 in the past twelve months

Full-text downloads displays the total number of times this work’s files (e.g., a PDF) have been downloaded from QUT ePrints as well as the number of downloads in the previous 365 days. The count includes downloads for all files if a work has more than one.

ID Code: 17790
Item Type: QUT Thesis (PhD)
Supervisor: Gesche, Astrid & Isaacs, Peter
Keywords: ethics, prenatal screening, informed consent, education
Divisions: Past > QUT Faculties & Divisions > QUT Carseldine - Humanities & Human Services
Past > Schools > Social Work & Human Services
Institution: Queensland University of Technology
Deposited On: 12 Feb 2009 02:35
Last Modified: 28 Oct 2011 19:51

Export: EndNote | Dublin Core | BibTeX

Repository Staff Only: item control page