Autonomy, Danger, and Choice:The Moral
Imperative of an “At Risk” Pregnancy for a Group
of Low-Income Latinas in Texas
Linda M. Hunt and Katherine B. deVoogd
It is increasingly common in clinical medicine to assess the risk status of individual patients for various diseases or health outcomes and recommend treatments or other behaviors based on that assessment. The probability that an individual will develop a given condition is calculated based on epidemiological observations of characteristics associated with the distribution of the condition in the general population. Once classified as having an at-risk health status, the individual encounters an implicit social imperative to modify risk-related attributes or behaviors, for example, by avoiding or consuming certain substances or by accepting certain tests or services (Handwerker 1994; Kenen 1996; Rockhill 2001).
Risk assessment is particularly salient in the burgeoning field of genetic diagnosis. At present, clinical applications of our growing genetic knowledge are limited to risk-modeling of the statistical likelihood that an individual having a particular genetic profile will develop a given condition. There are currently no specific clinical interventions for modifying the genetic risk status of an individual, but only techniques designed to assess the likelihood of a gene's manifestation or reproduction.
We wish to thank the San Antonio Area Foundation for a generous grant in support of
this project. Julia Sargent made many important contributions to the data analysis and
interpretations presented in this chapter. Elizabeth Cameron and Holly Dygert also as-
sisted with data analysis. Many thanks to Carole Browner, who was integrally involved
in conceptualizing the research we report here and generously shared her research in-
struments with us. Dr. Browner also provided thoughtful comments on an earlier draft
of this chapter. We also wish to thank the staff and patients of the Prenatal Genetics
Clinic, whose kind cooperation made this project possible.