In addition to the issues involved in one mode of screening or another, there are overarching ethical issues that concern the entire project of prenatal diagnosis. These involve contestations over the meaning, experience, and implications of these tests. Specifically, there is a lack of clarity about the centrality of pregnancy termination to an offer of prenatal testing; whether testing resolves or creates maternal anxiety; and the relationship of individual reproductive choices to societal effect. This latter includes the effects of prenatal testing on those with disability and, more broadly, the relationship between prenatal screening programs and eugenics. Related to the latter is a question about the effectiveness of individual autonomous choice as a safeguard against eugenic abuses related to prenatal testing. All these issues affect and are affected by the lack of a mechanism for rational deliberative decision-making in the United States about why and which prenatal tests are developed and offered.
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