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injuries. Such strategies will greatly reduce the incidence of birth- related lawsuits while
providing excellent, cost-effective medical care.
A. Genetic Counseling
Three factors are combining to complicate the ethics and the law of genetic counseling.
The first is the tightening of restrictions on abortion. Great advances have been made
in postconception genetic testing, but the objective of most of these determinations is
to allow the patient to make an informed choice of an abortion. The second is the
publicity surrounding the human genome project. Although this project only extends
existing work on mapping and identifying the chromosomal basis for hereditary traits
and diseases, it has gotten extensive publicity. This is partly because the federal
research grant funding this project allocates several million dollars a year for legal and
ethical research. This money has created an industry of conferences and articles on the
potential societal problems of doing genetic research and has fueled both unreasonable
fears and expectations. [Beckwith J. The human genome initiative: genetics’ lightning
rod. Am J Law Med. 1991;17:1.]
The third factor is a backlash to the medicalization of pregnancy. A primary
manifestation of this backlash is the willingness of women to sue their physicians if
their baby is born with a defect. Many women interpret the marketing of obstetric
services as a guarantee of a healthy baby, and physicians reinforce this message by
implying that women who do not follow their recommendations have a greater chance
of having a defective baby than women who do what their physicians recommend. This
factor is complicated for genetic counseling because society is ambivalent about the
proper goals of such counseling. In one author’s view, there are three overlapping and
conflicting models for genetic counseling: “1) as an assembly line approach to the
products of conception, separating out those products we wish to develop from those
we wish to discontinue; 2) as a way to give women control over their pregnancies,
respecting (increasing) their autonomy to choose the kinds of children they will bear;
or 3) as a means of reassuring women that enhances their experience of pregnancy.”
[Lippman A. Prenatal genetic testing and screening: Constructing needs and
reinforcing inequities. Am J Law Med. 1991;17:15.]
Conflicts over genetic counseling and obstetric care span the political spectrum.
Conservative religious groups object to abortion, whereas some radical feminist groups
decry high-technology obstetric care as a conspiracy against women. The stakes are
high. Few states provide high-quality community care to reduce the burden on families
with mentally handicapped children. Financial necessity requires that both parents
work outside the home in most families, complicating the care of disabled children.
The chance of children with mental disabilities finding productive work and some level
of independence becomes more problematic as American society shifts from a labor-
based economy to an information-based economy, although this can help individuals
with physical disabilities.
These factors combine to pressure women to strive for the perfect baby, while at the
same time creating a sense of guilt for not treating pregnancy as a natural, nonmedical
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