'Implications of culture and language barriers in informed decision-making for Down’s syndrome screening'

This page features my rough notes for an essay written in my second year of training as a student midwife. You  can see the post it relates to here, which is on essay writing help for nurses and midwives.

Introduction: What inspired my argumentative response?

• Downs syndrome screening is a contemporary problem and we need to sort out morality around it before technology progresses, and it progresses very quickly (**quote NICE guidelines xx)
• Informed choice for screening is really hard to get because the science is complicated and the subject is emotional (**quote research xxx)
• there's a possibility that women from ethnic minority backgrounds or with a language barriers are even more at risk of not getting true informed consent for screening because we don't speak their language/we don't appreciate their cultural/emotional/religious backgrounds (**reference case study xx and news article xx)
• They are at risk and it is our professional responsibility to make sure equality of care is maintained (**Nursing and Midwifery Council Standards xxx)

(500 words)

Background: What preceded my argument and / or what needs to be clarified? 

• Explain the history of screening, and why it's so important in today's society (maternal age, women's expectations, the NHS has the technological ability to screen so therefore we have a moral obligation to carry out screening on women who want it)
• Explain exactly what Downs syndrome is and why some women terminate a pregnancy based on it (NICE guidelines)
• Explain about false positive results (Royal College of Obstetricians Green Top Guidelines xxx)
• Explain briefly the type of screening available, and how sometimes it causes miscarriage (NICE guidelines)
• Explain briefly the impact of religion or culture on these results. Explain how language services are not used often enough in the NHS (NHS source quote)

(500 words)

Confirmation: What supports my argument?

• Issues around screening are very important to get right: if we don't get it right, someone could end up with a pregnancy they feel they should have been able to terminate/child with a poor quality of life (quote journal xxx)/we could cause psychological damage through abortion or screening (quote/reference textbook xxx)/we could cause excess money to be used in legal cases if we haven't properly counselled women about screening (NHS statistics quote xxx)
• Since before the start of the NHS we have always had ethnic minorities in England and women with language barriers.  There are going to be more of these women, not less in years to come (quote government statistics on birth rates rising xx), so to give good care, we need to communicate with them well
• CEMACE reviews say more women and babies die from ethnic minorities/who can't speak english; not giving them good care around Downs syndrome screening may add to this effect for reasons to do with trusting healthcare services

(700 words)

Refutation: What challenges my argument?

• Language line and other translation services are expensive so maybe in the NHS we shouldn't use them. Refuting this: a legal case brought against the NHS by a mother who wasn't happy with screening could be far more expensive (quote NHS stats). Also it is our professional obligation to give good care to all women equally (quote Nursing and Midwifery Council Standards)
• Teaching midwives and staff about many different cultures is expensive; you could argue these women should learn English and understand our culture is they're in this country having a baby. Refuting this: many don't choose to be here as are in arranged marriages (quote research xxx), or are in low socio-economic surroundings meaning they don't have the facility to learn english (quote research xxx), and besides as health care professionals it is in our standards not to judge based on race or background and give an equal quality of care (NMC guidelines xxx)
• Some say Downs syndrome shouldn't be screened for at all as every life is sacred, and there are various activist groups (quote xx). Refuting this: now screening is available it would seem morally wrong and patronising  not to allow women to make their own decision regarding screening (quote from journal xxx)
• Stress regarding screening may do women more harm than good, and Downs syndrome is rare so maybe we shouldn't screen at all. Refuting this: we cannot tell which women will have Downs syndrome babies, therefore we have to ask all of them what they would like in the way of screening or it would be unfair and an not evidence based way to practice (quote journal xxx)

(700 words)

Conclusion: What are the benefits of accepting my argument?

• CEMACE report tells us women and babies from ethnic minorities die/get ill/harmed much more often.  If we make sure women are communicated with well, we will see less psychological damage, which will cost less for the NHS. These women will also trust us more if they are looked after appropriately and will make contact if unwell or worries. If we look after them well in this area, which is complicated and controversial, it will stretch to other areas of their care and bring down mortality and morbidity as a whole. (quote CEMACE xxx)
• Overall if we get screening right for all women, it's a good indication maternity services are communicating well with their clients, and using the advanced technology of today in a humane and woman centered way. This is core midwifery care and should be aimed for (quote textbook xxx).
• Downs screening is controversial in itself, but now the 'Pandora's box' of technology is open we can't close it, so we have to do the best job we can at making care evidence based, fair and equitable
• If we accept Downs screening is controversial, emotional, and difficult care to give especially surrounding ethnic women/those who don't speak English, we can make sure resources go to Midwives to be trained to counsel well and care will be better

(600 words)