Löwy Ilana
CERMES 3 (INSERM, CNRS, EHESS, Université Paris V), 7 rue Guy Moquet, 94801 Villejuif cedex, France.
Stud Hist Philos Biol Biomed Sci. 2014 Sep;47 Pt B:290-9. doi: 10.1016/j.shpsc.2013.12.003. Epub 2014 Jan 17.
Prenatal diagnosis was developed in the 1970s, a result of a partly contingent coming together of three medical innovations-amniocentesis, the study of human chromosomes and obstetrical ultrasound-with a social innovation, the decriminalization of abortion. Initially this diagnostic approach was proposed only to women at high risk of fetal malformations. Later, however, the supervision of the fetus was extended to all pregnant women. The latter step was strongly favoured by professionals' aspiration to prevent the birth of children with Down syndrome, an inborn condition perceived as a source of suffering for families and a burden on public purse. Experts who promoted screening for 'Down risk' assumed that the majority of women who carry a Down fetus will decide to terminate the pregnancy, and will provide a private solution to a public health problem. The generalization of screening for Down risk increased in turn the frequency of diagnoses of other, confirmed or potential fetal pathologies, and of dilemmas linked with such diagnoses. Debates on such dilemmas are usually limited to professionals. The transformation of prenatal diagnosis into a routine medical technology was, to a great extent, an invisible revolution.
产前诊断始于20世纪70年代，是三项医学创新——羊膜穿刺术、人类染色体研究和产科超声——与一项社会创新——堕胎合法化——部分偶然结合的结果。最初，这种诊断方法仅针对胎儿畸形高危女性提出。然而，后来对胎儿的监测扩展到了所有孕妇。后一步骤受到专业人士愿望的强烈推动，即防止唐氏综合征患儿的出生，这种先天性疾病被视为家庭痛苦的根源和公共财政的负担。推动“唐氏风险”筛查的专家认为，大多数怀有唐氏胎儿的女性会决定终止妊娠，并将为一个公共卫生问题提供一个私人解决方案。唐氏风险筛查的普及反过来又增加了其他已确诊或潜在胎儿疾病的诊断频率，以及与此类诊断相关的困境。关于此类困境的辩论通常仅限于专业人士。产前诊断转变为常规医疗技术在很大程度上是一场无形的革命。
