Fetal alcohol screening and ethics
George F Winter explores maternal alcohol consumption and the moral and clinical influences that govern advice on drinking alcohol during pregnancy
The diagnosis of fetal alcohol syndrome was first established by Jones et al (1973), who described what ‘seems to be the first reported association between maternal alcoholism and aberrant morphogenesis in the offspring.’ They investigated eight children from three ethnic groups, finding ‘a similar pattern of craniofacial, limb and cardiovascular defects associated with prenatal-onset growth deficiency and developmental delay’ (Jones et al, 1973).
That was a medical diagnosis. However, demonstrating the difficulty of establishing a clear boundary between facts and values, Armstrong (1998) asserts that fetal alcohol syndrome also exemplifies the social construction of a clinical diagnosis. She argues that ‘[fetal alcohol syndrome] is a moral as well as a medical diagnosis, reflecting the broader cultural concerns of the era in which it was discovered’ (Armstrong, 1998). These cultural concerns included a heightened awareness of environmental threats to health, the development of fetal medicine and an emphasis on ‘the perfect child’.
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