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Frames of decision-making in prenatal consultations in England and France. Towards a sociological, relational and processual approach to autonomy
  • Isabelle VILLE,
  • Caroline Lafarge
Isabelle VILLE
INSERM
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Caroline Lafarge
University of West London - Brentford Site
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Abstract

Rationale, aims and objectives The article looks at how, during consultations, pregnant women identified as presenting an increased risk of giving birth to a child with an impairment, and practitioners in the field of prenatal diagnosis, decide whether or not to accept the risk of a miscarriage and proceed with a diagnostic examination. Methods We conducted 63 observations of consultations in France and 22 in England. Participants were women for whom an elevated risk of abnormality had been identified and the practitioners involved in their care. Our analytical approach consisted in suspending the normative concepts of non-directiveness and autonomy, and in drawing on Goffman’s (1974) notion of “frame” to take account of the experiential and structural aspects that the protagonists bring into the (inter)actions. Results We identified four frames: medico-scientific expertise, medical authority, religious authority and compassion. Observation of the ways in which the frames intertwine during consultations revealed configurations that facilitate or hinder the fluidity of the interactions and the decision-making process. The medico-scientific expertise frame, imposed by the guidelines, heavily dominated our observations, but frequently caused distress and misunderstanding. Temporary or sustained use of the compassion and/or medical authority frames could help to repair the discussion and create the conditions that enable women/couples to reach a decision. Variations in configuration highlighted the differences between practitioners in the two countries. Conclusions Combining frames allows protagonists to exert reflective abilities and to maintain/restore interactions. The frame analysis promotes a vision of autonomy that is sociological, relational and processual rather than philosophical. The frames are anchored in different structural conditions in England and France.

Peer review status:ACCEPTED

09 Dec 2019Submitted to Journal of Evaluation in Clinical Practice
09 Dec 2019Assigned to Editor
09 Dec 2019Submission Checks Completed
11 Dec 2019Reviewer(s) Assigned
25 Jan 2020Review(s) Completed, Editorial Evaluation Pending
25 Jan 2020Editorial Decision: Accept