Rhetoric, Disability, and Prenatal Testing: Down Syndrome as an Object of Discourse

Abstract

This project considers how disability studies and rhetorical studies—specifically the area of medical rhetoric—might usefully inform one another. In particular, this project examines prenatal testing for Down syndrome as a rhetorical situation that initiates and circulates many different discourses about Down syndrome. Chapter One begins by examining a frequently cited statistic in critiques of prenatal testing—the estimated pregnancy termination rate after a prenatal diagnosis of Down syndrome. It explores the validity of this statistic and uses this discussion to suggest that the effects of prenatal testing on social understandings of Down syndrome are complex and largely unknown. Chapter Two argues that intellectual disabilities, like Down syndrome, are underrepresented in disability studies literature and that their absence can be partially attributed to models of disability used in the field. Chapter Three argues that rhetorical analysis provides a means of examining how Down syndrome is discursively constructed. Chapter Four describes the events of prenatal testing for Down syndrome and analyzes the events as a rhetorical situation. In addition, it reviews feminist, disability, and cultural critiques of prenatal testing demonstrating the strengths of each strand of scholarship and suggesting where rhetorical analysis might provide new information. Chapters Five and Six provide analysis of two commentaries on the rhetorical situation of prenatal testing—genetic counseling discourse and parent discourse. These chapters find that ideal genetic counseling discourse offers pregnant women some opportunities to resist medicalization but also exhibits tension between what counselors say they do and what their rhetorical practice affords, especially regarding disability. In addition, analysis shows that users of prenatal testing are concerned with several factors of decision-making that are either not emphasized or ignored entirely in genetic counseling discourse. This project concludes that although different discourses about Down syndrome are available, elements of the prenatal testing situation make it easier for participants to draw on some discourses rather than others. Furthermore, it appears that certain events in the prenatal testing situation—such as the offer of amniocentesis—operate rhetorically in tacit ways, obscuring the relationship between the choice to undergo genetic screening and perceived meanings of Down syndrome.