The Physician and the Hopelessly Ill Patient: Legal, Medical and Ethical Guidelines

between women in terms of probability ofrisk to an unborn child and offer a test which, to be effective in population terms, will lead to being offered termination of an abnormal fetus.Such screening would generally be for Down's Syndrome and would only be performed after agreement of the mother to abort an affected fetus.To respond to a woman's request for such tests may be morally acceptable, but to sow seeds of doubt in the mind of a pregnant mother who hitherto had no worries, and to offer her the death ofher baby as the sole solution may be ethically unacceptable.There is no evidence put forward as to who these high-risk women are, nor of the proportion of women in these groups likely to find this method of prevention morally or ethically acceptable.It would have been interesting to have examined the acceptability and efficacy of such programmes elsewhere.In addition, one would have expected a health economist to have looked more closely at the issues of likely cost-effectiveness of such a screening policy.The application of currently accepted criteria for monitoring a screening programme would have been illuminating.Despite these reservations, the author reflects a body of current opinion, concerned to make things work, to provide 'good' community care, though possibly at the expense of families and the community, and to involve statutory and voluntary sectors more in working together.The problems have been realistically analysed but a lot more effort must be directed to finding convincing and ethically acceptable solutions.