Prenatal Diagnosis in France: Between Regulation of Practices and Professional Autonomy.

Prenatal diagnosis (PND) was introduced in France in the 1970s on the initiative of medical researchers and clinicians. For many years the regulation of practices was self-imposed, decentralised and idiosyncratic. The advent of 'therapeutic modernity' in the 1990s gave rise to an ethical, legal and scientific framework designed to homogenise PND at a national level, with the creation of multidisciplinary centres (CPDPN) and the Agence de la biomédecine. This article first recovers the history of PND in France. It then compares the activities of two CPDPNs, using ethnographic fieldwork and by analysing national quantitative data compiled by the Agence. It argues that the official policy of nationally homogeneous practices is not born out in practice, at the local level. This lack of homogeneity is most apparent in the number of authorisations for pregnancy termination due to foetal malformation, which varies considerably from one centre to another. Rooted in local culture, this variation relates to organisational methods, decision-making processes and variable levels of tolerance towards the risk of disability. Foetal medicine practitioners, thus, maintain a certain amount of autonomy that is collective rather than individual and that is reflected in the particular 'identity' of a given centre.

Ectopic pregnancy: how the diagnostic and therapeutic management has changed.

Nowadays ectopic pregnancy often can be diagnosed before the woman's condition has deteriorated, which has altered the former clinical picture of a life-threatening disease into a more benign condition. This review describes the historical developments in the diagnostic and therapeutic management of ectopic pregnancy leading up to current clinical practice. The first attempts to diagnose ectopic pregnancy originate from the beginning of the 20th century.

Jérôme Lejeune (1926-1994): father of modern genetics.

Jérôme Lejeune's greatest achievement was the discovery of the genetic basis of Down's syndrome, which he named trisomy 21. His important research in human genetics, as well as his humanitarian spirit and fight against therapeutic abortion, rightly led to his recognition as the founder of modern genetics.

The King versus Aleck Bourne.

The case that established the lawfulness of terminating pregnancy to preserve women's health.

The American College of Obstetricians and Gynecologists and the evolution of abortion policy, 1951-1973: the politics of science.

The autonomy granted to physicians is based on the claim that their decisions are grounded in scientific principles. But a case study of the evolution of the American College of Obstetricians and Gynecologists' abortion policy between 1951 and 1973 shows that decisions were only secondarily determined by science. The principal determinant was the need to preserve physician autonomy over the organization and delivery of services. As a result, the organization representing physicians who specialized in women's reproductive health was marginal to the struggle for legalized abortion. But, the profession was central to decisions about whether physicians would perform abortions and how they would be done. This case study finding has implications for understanding the role that organized medicine might take in the ongoing debates about national health policy.

The chapel and the operating room: the struggle of Roman Catholic clergy, physicians, and believers with the dilemmas of obstetric surgery, 1800-1900.

By 1800, the Roman Catholic Church and organized medicine faced the dilemma of how to resolve cases of obstructed births. American physicians usually practiced destructive operations, like craniotomy, in an attempt to save the lives of mothers. The church allowed such operations after the death of the infant. A new technique of surgery, the cesarean operation, offered hope that both patients would survive childbirth. Medical progress, and an emerging Catholic belief that the fetus was human, prompted Catholic physicians to advocate the new operation, and stirred a renewed debate among European theologians on the propriety of craniotomy. In America, the broad Christian tradition promoted by the Catholic Church began to inform medicine on the moral and ethical parameters of surgery. American physicians, for their part, engaged in their own debate on the propriety of the cesarean operation. This article, focusing on the cesarean debate, reveals the intersections of Catholicism and medical progress amid the growth of obstetric surgery from 1800 to 1900.

Screening Jews and genes: a consideration of the ethics of genetic screening within the Jewish community: challenges and responses.

Screening for genetic disorders, particularly Tay-Sachs Disease, has been traditionally welcome by the Jewish community. I review the history of genetic screening among Jews and the views from the Jewish tradition on the subject, and then discuss ethical challenges of screening and the impact of historical memories upon future acceptance of screening programs. Some rational principles to guide future design of genetic screening programs among Jews are proposed.

Abortion policy and politics on the Lane Committee of Enquiry, 1971-1974.

The 1967 Abortion Act did not quell public discussion on therapeutic abortions in Britain. Criticism of the way the Act was working began almost as soon as the legislation came into force. After only three years, a committee of enquiry, chaired by Justice Elizabeth Lane, studied the working of the Act. This Committee caused some surprise on all sides of the abortion debate by offering unanimous support for the Act in its original form. Understanding how the Lane Committee arrived at its unexpected recommendations is important not only because the Report has proved to be an enduring endorsement of the Act but also because the Lane Committee provides a case study of the process of policy formulation at the level of a committee of enquiry. The Lane Committee appears to have achieved consensus incrementally. First a majority and then the whole Committee supported the Act as a humane measure requiring regulatory and not legislative solutions to the problems of its working. Using both written and oral sources, I will argue that consensus evolved through the compelling leadership of several key members of the majority group with particular influence by the most psychosocially oriented members of the Committee.

[Changes in the legislation regulating the legal status of artificial abortion in the world in the past 10 years]. / Izmenenie na zakonodatelstvoto, koeto regulira pravniia rezhim na izkustveniia abort v sveta prez poslednite 10 godini.

PIP: Current status of abortion legislation in different countries is reviewed. During the period from 1967-1977, a total of 43 countries introduced certain changes in their legislation. Of these 43 countries, 40 liberalized abortion procedures and 3 countries limited the rights of abortion seekers. Liberalization of abortion legislation in France and Italy was associated with women's rights movement and adoption of Human Rights Declaration. Austria, France, East Germany, West Germany, Italy, Sweden, Norway, and Denmark have the most liberal abortion policy, while Rumania, Hungary, Czechoslovakia, and Bulgaria have the most restricted legislation. Liberalization of abortion does not necessarily mean availability on demand. High cost in private clinics and hospitals prevents many women from seeking a legal abortion. In Asia, Singapore, China, and India permit abortions, while in the Philippines, Indonesia, and Burma abortions are banned. In Northern and Latin America, abortions are legalized in the US and Cuba; liberalization of abortion legislation is recorded in Guatemala, El Salvador, Uruguay, Chile, and Colombia. In spite of a general liberalization of legislation, abortion policies are still affected by religious and political groups. Ban on legal abortion increases the frequency of criminal abortion, which in turn leads to increase in maternal mortality.^ieng

Looking back at Luenbach: 296 non-hospital abortions.

PIP: 296 nonhospital abortions using an abortifacient paste method are examined in support of the outpatient abortion. Patients ranged in age from 11 to 47 years, 20% were married, and 98% were in the poverty or lower income level. The patients were seen at 2 1/2 months gestation. Under sterile conditions in a doctor's office 10-40 cc of a high viscosity paste - potassium neutral soap with KI and thymol, borne in a multitincture menstruum - was admitted by syringe into the internal os. The method paralleled the Luenbach paste method but abrasives were absent. The paste impaired circulation between zygote and chorion frondosum. On the 2nd day ergotrate was given. Flow lasted 3-7 days. There was frequent follow-up by phone. Check-up vaginals were done at 1 and 3 weeks. 78% had excellent results. 11% needed 2-3 weeks treatment with carbazochrome salicylate, vitamin K, or medrozyprogesterone acetate. 3% required dilatation and curettage. The 6% failures should be considered operator failures in misjudging length of gestation. Sepsis, serious complications, or fatality were absent with this method. Preliminary history omitted cases from this method that might preclude complications. The success with these cases indicates that the nonhospital, paste-induced abortion can be both effective and safe.^ieng