Biomedical Engineering Reference
In-Depth Information
to detect abnormality, has been discussed as contributing to a wider shift
in the relationship between lay people and medicine (de Swaan 1990).
Screening for a particular abnormality confronts people with 'a small risk
of a great misfortune' (ibid.) in those who see themselves as healthy. Even
simply belonging to a population, such as pregnant women, will in this sense
offer a status of 'being-at-risk' (Lupton 1995; Scott
et al
. 2005). As the
development of new medical technology continuously adds new possibilities
to detect deviance at an early stage, new states of 'being-at-risk' are being
created. This, in turn, raises questions about the meaning of the status of
being-at-risk for those who are subject to screening.
For the individual, screening seems to enhance an uncertainty about
health and normality, an uncertainty that goes beyond test results that
confi rm normality (Davison
et al
. 1994). Earlier studies of various types of
screening have shown how people struggle to understand the outcome of
screening tests, often presented as a fi gure or a chart, and also how they try
to make sense of these outcomes in the context of their life-worlds (Parsons
and Atkinson 1992). Just being subject to screening can evoke uncertainty in
the individual, even when no deviance is found (Adelswärd and Sachs 1996;
Olin Lauritzen and Sachs 2001). Of particular interest is how people with
not normal outcomes are placed in a liminal zone, 'between and betwixt'
health and illness, as they wait for defi nite results (Forss
et al
. 2004; Scott
et
al
. 2005) and how anxiety and worries can remain even after confi rmation
of normal results (Green 1990; Statham 1993; Santalahti 1996).
The ultrasound scan, as such, is something that pregnant women
3
as well
as the population in general nowadays are familiar with and take for granted
as part of maternity health care.
4
The offer to have an ultrasound scan is
not often refused (Swedish Council on Technology Assessment in Health
Care 1998). One central feature of the ultrasound scan is that it visualizes
the inner body of the pregnant woman and makes the foetus the object of
a medical as well as parental 'gaze'. As Ann-Cristine Jonsson points out in
Chapter 5 in this volume, the image of the expected baby produced by the
ultrasound technology is seen and interpreted from a professional as well as
parental perspective at the ultrasound examination, and typically commented
on from both perspectives in terms of the normality of the baby. Previous
studies of parents' experiences of the routine ultrasound scan have shown
that the scan is understood primarily as a routine test to confi rm normality
and as a social event when they are given the opportunity to see the baby
for the fi rst time (Sandelowski 1994; Baillie
et al
. 2000). For many parents-
to-be, the ultrasound scan has such an important confi rmative role that they
wait until after the examination before announcing the pregnancy (Eklin
et
al
. 2004). However, they are not always aware of the medical purpose of the
examination (Marteau 1995; Al-Jader
et al
. 2000; Garcia
et al
. 2002).
Ultrasound screening for Down syndrome, however, is a technology that
is new in several ways. First, it makes possible a new type of screening of the
foetus, that is to detect foetuses with an increased risk of Down syndrome.
