The ‘risk of knowing’ talk and decision-making in prenatal screening for Down’s syndrome in Hong Kong’

Abstract

This paper examines the ‘risk of knowing’ talk (Sarangi et al. 2003, p.155) in prenatal screening for Down’s syndrome in Hong Kong. The ‘risk of knowing’ talk refers to the consequences of learning about a health condition, such as the psychosocial and interpersonal implications of testing, and the subsequent management of the condition. The stigma of eugenics and that the termination of pregnancy is the only available ‘medical intervention’ imply that the risk talk and decision-making in prenatal screening carry serious ethical, moral and social implications (Pilnick and Zayts 2012). This issue has not attracted much attention in the previous literature. This study is part of a larger project on prenatal screening conducted in one Prenatal Diagnostics and Counselling Department of a Hong Kong hospital in 2007-2012. It draws on 20 video-recorded consultations with pregnant women who have received a ‘positive’ (high risk) screening result and are invited to consider further diagnostic testing. Using theme-oriented discourse analysis (Roberts and Sarangi 2005), we show that in these consultations the ‘risk of knowing’ talk is not initiated by the healthcare professionals. It may, however, be evoked by women. We examine the impact of the ‘risk of knowing’ on decision-making, and discuss specific discourse (linguistic and rhetorical) devices that the participants employ to negotiate three competing agendas in these encounters: the healthcare professionals’ preference of diagnostic testing; clients’ concerns of having a baby with Down’s syndrome; and the overarching professional goal of these encounters of facilitating the clients’ informed choice regarding further testing.