Understanding Mordel: obtaining informed consent for trisomy screening
The landmark decision of Montgomery has established that the patient's right to self-determination and autonomy underpins the doctrine of informed consent. The case of Mordel threw into question the process of obtaining informed consent and whether it was being sufficiently secured in the context of Down's syndrome screening. This case conveyed a paradigm shift to the role of the midwife and sonographers when obtaining consent for screening and the requisite legal standard of care they owe to expectant parents. However, many key issues remain unanswered from the decision in Mordel, in particular, what steps must healthcare professionals take to discharge their duty of care in the process of securing informed consent from expectant parents for screening.
Screening for fetal anomalies during the antenatal period remains a controversial issue in midwifery and reproductive health practice. The traditional ‘Down's syndrome’ antenatal screening pathway is currently going through a period of significant development across England and Wales. Between 2016–2018, following the UK National Screening Committee ([UK NSC], 2013) recommendations, both NHS England (2017) and Wales implemented the new ‘trisomy’ screening pathway (Antenatal Screening Wales, 2019).
‘Trisomy’ is the medical term used to describe the presence of an additional chromosome in some or all of the cells of a person. For example, trisomy 21, or Down's syndrome, is characterised by an additional chromosome 21. Under the new pathway, Down's syndrome (trisomy 21), the most common chromosomal condition detected antenatally would be joined by the second and third most commonly detected chromosomal conditions, Edwards' syndrome (trisomy 18) and Patau's syndrome (trisomy 13), to form the ‘trisomy’ screening pathway.
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