Leading Article: The right to a perfect baby

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MICHELLE HUBERMAN was not told about a test that might have given an indication that she risked having a Down's syndrome baby. She is now planning legal action against the well-known obstetrician, Dr Yehudi Gordon, in whose hands she had placed herself at an expensive private hospital. He did not offer her the predictive blood test (which was then not widely available) because he felt it increased the number of youngish women (such as Mrs Huberman, who is 34) having amniocentesis - a test carrying a risk of miscarriage. Mrs Huberman says the choice should have been left to her. She is claiming pounds 1m damages for herself and her seven-month-old Down's syndrome daughter, Annalie.

The case raises several important and interesting issues. Do women have the right to expect their babies to be more or less perfect? Should no expense be spared to reduce the risk of babies being born with physical defects and handicaps? By implication, are we becoming a society that cannot or does not want to cope with people who are different?

Advances in medical knowledge have, as in so many other fields, created ever-rising expectations. Thirty years ago it was known that women older than, say, 35 were more likely to produce a handicapped child. Beyond that it was impossible to assess the risks. So when the blow fell, it was softened for many parents by an element of fatalism. Nowadays people are more demanding. They want, where possible, to know why they were singled out; and they may well seek to blame their doctor. In America, a country of voracious lawyers, as even President George Bush complained in his speech last Thursday, the reaction is not just to blame but to sue. It is now up to the obstetricians to prove that any small flaw in the baby is not their fault.

The consequences, at least in lawyer-prone areas of the US, have been appalling. Patients are liable to be submitted to a wide range of expensive, unnecessary and anxiety- raising tests purely for legal reasons. More and more babies are delivered by Caesarean section, in case they are damaged as they seek their natural exit or, more hazardous still for medical staff, are helped out with forceps. Insurance premiums for obstetricians have become so exorbitant that many practitioners have switched to other, safer fields.

It would be sad if that attitude were to spread to this country. 'Defensive medicine' corrodes the mutual trust that should characterise the doctor-patient relationship. Obstetricians have to assess the degree of risk each patient runs, and advise accordingly. Occasionally their advice will be proved wrong. If they feel obliged to protect themselves by automatically recommending all known tests, the cost could be prohibitive, both financially and in terms of trust; and the impression that a handicapped child represents a failure of the system would be strengthened.

Everyone knows what a strain such children can place on their parents. Happily, there is also overwhelming evidence that, for many mothers and fathers, the experience is enormously enriching: the hardships are balanced by the response of the child and the help extended to them by relatives, friends and specialised institutions. Were medical science ever to make it possible, a society in which only normal children were born would be emotionally impoverished.