Nobody's Child, Everybody's Children:

Narratives of the Unspeakable: Attending to the Silence

In January of this year, I began a full-time residency in clinical ethics. This shift in institutional context, from a university department to a teaching hospital, has deeply affected my ability to articulate (or be satisfied with) neatly defined abstract conclusions. This relocation has engendered a deepening sense of moral distress, as I have lost the ability to rely on forms of ethical reasoning that previously grounded my normative commitments. Consider the following:

At 20 weeks gestation, a young woman is presented with the results of prenatal screening indicating a series of fetal anomalies. Prior to conception the woman and her partner had agreed that if diagnostic testing revealed disabling conditions, she would terminate the pregnancy. After much struggle, she affirms the decision to abort. Their grief and anguish is palpable. Preparations for their first child are halted. The woman says she will tell others she has miscarried.

For many women, such decisions seemingly wrap them in a shroud of silence beyond the walls of the clinic. In North America, prenatal testing and the assumed outcomes of positive results are becoming further entrenched and clinically normalized. Yet despite this implied social acceptance, open discussions surrounding selective terminations remain taboo. Women are socially isolated, their experiences kept secret, and their grief disenfranchised.

In many respects genetic screening offers a form of technological surveillance procuring security from the unwanted kind of child. Yet the manner in which the notion of 'the unwanted kind of child' is understood varies from context to context. Different institutional settings allow for differing modes of reasoning and moral justification. While we carry with us the consequences of decisions made elsewhere, the institutionalized discourses upon which these decisions are made are not always so readily transportable. One must somehow ameliorate 'the unwanted kind of child' of the biomedical model with 'the unwanted kind of child' who was to be a member of one's family. In this paper, my intention is not to engage in the broader debate surrounding genetic testing and selective abortions. Rather, I employ my clinical encounters with these practices to illustrate the absence of an ethical language that might do justice to the experiences such practices construct. Drawing from the literature base of narrative ethics, I explore new avenues of ethical expression and responsiveness in hope that our technological advances do not continue to abandon us in the realms of the unspeakable.