Reproductive Autonomy in Light of Expanded Prenatal Genomic Testing

Abstract

Genomic-based testing in reproduction is expanding, with more tests offered to more people for more indications. These tests are offered in the name of reproductive autonomy. However, 'reproductive autonomy' is often interpreted to over-emphasize maximal choice and information, overlooking the role of relationships and structural influences. In this paper, we consider how reproductive autonomy can be conceptualized to be useful for challenges presented by expanded prenatal genomics. After critically examining the epistemological assumptions connecting (genomic) information and autonomy, as well as the ideological pressures these tests potentially intensify, we present and defend a more fitting approach to reproductive autonomy. Our account is characterized by relationality, substantivism, the fulfillment of certain institutional conditions, and the provision of adequate options. By providing deeper philosophical context to the way we understand reproductive autonomy in expanded prenatal genomic testing, our approach nuances how the offer and uptake of prenatal genomic testing should progress.

Keywords: Feminist bioethics; genomics; pregnancy; prenatal diagnosis; relationality; reproductive autonomy.