Another development has been the introduction of commercial testing. In the Netherlands, at the end of the 1990s, commercial AR-13324 mouse companies started to offer so-called ‘ultrasounds for fun’, making it possible to have intrauterine pictures of the foetus. The fact that foetal anomalies were occasionally detected in the presence of parents who had not received any counselling was an extra impetus to regulate screening. Although a range of genetic tests is currently offered on the internet (Borry et al. 2010), until now prenatal testing has been

predominantly offered via established centres of health care. However, the trend for commercialisation also implies that the ‘old’ governmental policy of not offering

screening as a way to protect people against potential harm is becoming obsolete. If certain tests are not offered by the government, GSK2118436 people may arrange BI-D1870 nmr to have testing in other, perhaps commercial, centres or hospitals in other countries, or via the internet. Conclusion and discussion: Individual versus collective effects In this new era, the individual woman or couple has gained more options to make an informed choice of whether or not to have reproductive screening. In principle, the availability of high-quality testing and the ability to make an informed choice might be welcomed as a positive aspect of present-day health care in modern democracies. At the same time, it is relevant to note that individual choices add up to a collective effect: reproductive screening may become an increasingly ‘normal’ thing to do. Even if societal pressure is not explicit, implicit norms, comments and expectations from friends and family may frame the choices individuals can make. The sum of the individual choices may result in a ‘collective eugenics’ as visible in the number of screening tests being performed and in the reduction

of the Paclitaxel nmr live births of foetuses with serious disorders that can be detected prenatally. This mechanism, which is a cause for unease, can be demonstrated in other reproductive testing, such as Preimplantation Genetic Diagnosis (PGD) and will certainly surface again when new free foetal DNA testing is considered. In the Netherlands, in 2008, PGD became the focal point of a public debate and almost caused the downfall of the Cabinet (Huijer 2009). PGD had been applied rather unproblematically on a very small scale, for a handful of couples with a high risk of serious disorders in their offspring. When the government prepared new regulation of this practice, a public debate ensued in newspapers and on the television, among other things, over the question of whether disorders that are not fully penetrant, such as hereditary breast cancer, would also be eligible for PGD.