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17 Am. J.L. & Med. 15 (1991)
Prenatal Genetic Testing and Screening: Constructing Needs and Reinforcing Inequities

handle is hein.journals/amlmed17 and id is 23 raw text is: Prenatal Genetic Testing and
Screening: Constructing Needs
and Reinforcing Inequities
Abby Lippman*
This Article considers the influence and implications of the application
of genetic technologies to definitions of disease and to the treatment of ill-
ness. The concept of geneticization is introduced to emphasize the domi-
nant discourse in today's stories of health and disease and the social
construction of biological phenomenon is described. The reassurance,
choice and control supposedly provided by prenatal genetic testing and
screening are critically examined, and their role in constructing the need for
such technology is addressed. Using the stories told about prenatal diagno-
sis as a focus, the consequences of a genetic perspective for and on women
and their health care needs are explored.
During the past two decades, numerous techniques have been de-
veloped that allow geneticists to assess the physical status of the fetus
during a woman's pregnancy. The variety of prenatal diagnostic tech-
niques' and detectable/diagnosable fetal conditions continues to ex-
pand. These screening and testing procedures are already the most
widespread application of genetic technology to humans.
This paper, part of an ongoing project, explores the genetic sto-
ries' told about health and disease today, the storytellers and the
* Associate Professor, Dep't of Epidemiology & Biostatistics, McGill University. Prenatal
diagnosis, the focus of much of this paper, is troublesome for all women, users and critics
alike. In no way do I intend my remarks about it to reflect on women who have considered or
undergone testing; criticism of the technologies is not to be read as criticisms of them. Wo-
men considering childbearing today face agonizing issues I was fortunate enough not to have
to confront, and I can only admire their resilience and strength.
I See infra notes 20-26 and accompanying text for a discussion of these techniques.
2 In this Article, the word stories is not used to suggest that what is said is not true (this
may or may not be the case). Rather it is used in a literary, not a legal, sense to capture the
idea that how scientists present their observations and study results is no different from how
novelists present their interpretations of the external world. Raw material is shaped and
interpreted to convey a message by both groups, with their constructions reflecting the pre-

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