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Ethics, justification and the prevention of spina bifida
  1. Wendy Jane Gagen,
  2. Jeffrey P Bishop
  1. Peninsula Medical School, Universities of Exeter and Plymouth, The Knowledge Spa, Truro, UK
  1. Correspondence to:
 Dr W J Gagen
 Peninsula Medical School, Universities of Exeter and Plymouth, The Knowledge Spa, Truro TR1 3HD, UK; wendy.gagen{at}


During the 1970s, prenatal screening technologies were in their infancy, but were being swiftly harnessed to uncover and prevent spina bifida. The historical rise of this screening process and prevention programme is analysed in this paper, and the role of ethical debates in key studies, editorials and letters reported in the Lancet, and other related texts and governmental documents between 1972 and 1983, is considered. The silence that surrounded rigorous ethical debate served to highlight where discussion lay—namely, within the justifications offered for the prevention of spina bifida, and the efficacy and benefits of screening. In other words, the ethical justification for screening and prevention of spina bifida, when the authors are not explicitly interested in ethics, is considered. These justifications held certain notions of disability as costly to society, with an imperative to screen and prevent spina bifida for the good of the society.

  • AFP, α-fetoprotein
  • DHSS, Department of Health and Social Security
  • NHS, National Health Service

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  • Competing interests: None.

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