Aiming towards "moral equilibrium": health care professionals' views on working within the morally contested field of antenatal screening.
OBJECTIVE: To explore the ways in which health care practitioners working within the morally contested area of prenatal screening balance their professional and private moral values. DESIGN: Qualitative study incorporating semistructured interviews with health practitioners followed by multidisciplinary discussion groups led by a health care ethicist. SETTING: Inner city teaching hospital and district general hospital situated in South East England. PARTICIPANTS: Seventy practitioners whose work relates directly or indirectly to perinatal care. RESULTS: Practitioners managed the interface between their professional and private moral values in a variety of ways. Two key categories emerged: "tolerators", and "facilitators". The majority of practitioners fell into the "facilitator" category. Many "facilitators" felt comfortable with the prevailing ethos within their unit, and appeared unlikely to feel challenged unless the ethos was radically challenged. For others, the separation of personal and professional moral values was a daily struggle. In the "tolerator" group, some practitioners sought to influence the service offered directly, whereas others placed limits on how they themselves would contribute to practices they considered immoral. CONCLUSIONS: The "official" commitment to non-directiveness does not encourage open debate between professionals working in morally contested fields. It is important that practical means can be found to support practitioners and encourage debate. Otherwise, it is argued, these fields may come to be staffed by people with homogeneous moral views. This lack of diversity could lead to a lack of critical analysis and debate among staff about the ethos and standards of care within their unit.