12 Prenatal screening for Down syndrome

At the turn of the century, several Western countries introduced prenatal screening for Down syndrome. Technology became widely and easily available, and the combination of ultrasound and then blood tests made it possible to screen the entire pregnant population. For the first time in history, there was a chance of detecting, and eventually aborting, most instances of Down syndrome, and at relatively low cost. Some countries chose not to offer early screening during pregnancy, using value-based arguments, often claiming solidarity to weaker members in society. Yet, the same countries typically accepted abortion and prenatal diagnosis based on previously established maternal-age criteria. This chapter investigates and discusses from a philosophical perspective whether there is a relevant difference between offering prenatal tests to high-risk groups as opposed to the entire pregnant population. Is this an ethical question, or a matter of more effective ways to introduce and use new medical technology? To screen or not to screen, that is the question.