Rapid development of sophisticated new techniques has vastly increased physicians' ability to detect congenital disorders before birth. Yet advances in treatment, before or after birth, have been very modest. This discrepancy leads to ethical and social problems that require serious attention by professionals and patients alike. This innovative book tackles such problems in the case of prenatal screening for neural tube defects. Afflicting about 7,000 newborn babies each year in the United States, neural tube defects are serious abnormalities in the development of the brain and spinal cord that have grave consequences for the child and family.

The editors, Elena O. Nightingale, a geneticist, physician, and expert in health policy, and Susan B. Meister, a specialist in parent-child nursing, social and developmental psychology, and quantitative methods, led a multidisciplinary effort by distinguished Harvard faculty, including economist Richard Zeckhauser and clinical decision analyst Barbara J. McNeil. Other contributors include Donald S. Shepard, Mary L. Kiely, and Stephen G. Pauker. The book examines the impact of technology assessment, cost effectiveness analysis, and decision analysis on reaching decisions about prenatal screening. The book includes a discussion of the results of formal analyses against a backdrop of our basic ethical and societal values, as well as the analyses themselves. Health care workers, policymakers, and concerned individuals will find this volume informative and thought provoking.