For neural tube defects, the possibility of performing an ultrasound in the second trimester was studied further as recommended. The Health Council had suggested

doing so, and representatives of obstetricians and midwives had urged to introduce this screening routinely, among others to strengthen the quality of standard care (Commissie Verloskunde 2003). Compared FK228 chemical structure to the end of the 1980s, now there was support among health care professionals for prenatal screening for neural tube defects. No treatment, no screening? We would like to argue that these new policy developments in prenatal screening for Down syndrome and neural tube defects marked a shift from an emphasis on treatability and collective protection against harm by banning screening. Instead, offering options has moved to the fore as suggested in 1994 by the Health Council. Women are now given a choice, based on adequate information, to screen or not to screen for disorders in their foetus for which no treatment (in the sense of cure) is available. However, currently, I-BET151 prenatal screening for Down syndrome is not offered as part of an official population screening programme to women of all ages. The information on the screening is provided to all women,

but women under 36 years of age have to pay for the screening themselves. To complicate the picture, a second trimester screening, the standard anomaly scan (SEO:

Structureel Echoscopisch Cediranib (AZD2171) Onderzoek), was introduced in 2007. It is offered to all pregnant women and reimbursed. Interestingly, this anomaly scan can detect both treatable conditions, such as certain cardiac AZD3965 anomalies, as well as untreatable conditions, such as severe neural tube defects. The character of the technology has made maintaining the strict separation between the field of argumentation of population screening for health purposes on the one hand and the field of argumentation of genetic testing for untreatable disorders on the other hand problematic.3 By introducing this screening, in fact, a new standard integrating elements of both fields of argumentation is developing. Although the standard anomaly scan does not resolve the conflicting aims of improving a foetus’ health outcome versus gaining information about a possibly untreatable disorder as a basis for reproductive options, the woman or couple can decide whether or not to have the screening test. Much attention is paid to providing women with adequate information about risk assessment testing, as well as the option to decide not be informed or not to have the screen. For Down syndrome screening, web-based decision aids have been developed (Raats et al. 2008; Meijer et al. 2010). This level of pretest information and counselling echoes the principle of informed choice in clinical genetics.