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.