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Jeffrey Wale – Nudging in disguise? Packaging prenatal tests and respecting patient autonomy.

InfoSoc Seminar Series

Wednesday 16 October 2019, 14:00, Room W416

This paper addresses the continuing debate over the availability and use of contingent prenatal DNA tests for anomaly pregnancy screening in the NHS. One contingent model is known as the ‘recall’ method and uses a two-stage screening process. Where stage 1 screening markers identify a higher chance of relevant anomaly, patients are recalled and given the option of proceeding to stage 2 which consists of either non-invasive DNA (commonly called Non-Invasive Prenatal Tests) or invasive (Amniocentesis or Chorionic Villus Sampling (CVS)) testing. Non-directive counselling is made available to the pregnant woman at this stage and before further testing occurs. Whilst the DNA tests are more accurate than the stage 1 markers, only the invasive tests are truly diagnostic. The alternative ‘reflex’ model retains a separate blood sample at stage 1, which is automatically used for DNA testing if the stage 1 markers identify a higher chance of relevant anomaly. In the reflex model, the patient receives an amalgam of the test results from stage 1 and 2 in a single data report. The central question is whether this packaging of tests, information and results matters for patients? Indeed, does the reflex model offer better ethical outcomes for patients than the alternative recall model. This debate has wider ramifications for medical screening and diagnostic tests which are often packaged together for cost benefit reasons.


Jeffrey Wale is Lecturer in Law at Bournemouth University