Ethical dilemmas of antenatal screening for Down's syndrome in primary care

Abstract

The case and the dilemmaAnwara is a 44-year-old Bangladeshi woman who is 18 weeks pregnant with her unplanned but wanted fourth child. She has had an integrated screening test (nuchal scanning and a blood test) which gives a risk of 1/5 for a foetus affected by Down's syndrome. She has poor English and comes to see me with an advocate. Before the result is disclosed to her, it becomes clear that she has not understood the implications of the screening test and would not have had the test performed had she been fully informed. Should I tell her the result, and does a consideration of ethics help me as her doctor to counsel her on what to do next?