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If supportive services are not to become financially too onerous,
an early solution to the problem of prevention of mental or physical
impairment seems imperative. In the meantime, rapid and accurate
ascertainment of handicap is essential if congenital disabilities are
to be contained or for medical interference to produce its most
beneficial effects.
With regard to genetic endowment there is a moral responsibility
in certain instances for the community to provide not only general
information but family planning and genetic counselling and a
similar responsibility rests with parents to balance their family
in accordance with this advice to ensure minimal handicap to their
offspring.
Already detection of abnormality in early pregnancy is a
distinct possibility, and it is likely that discovery of an aberration
in this way may well give rise, within the next decade, to an offer
of abortion as a routine procedure. Naturally, this will raise
ethical problems for both parents and community alike, but it is
the duty of a health authority to seek to avoid, wherever possible,
the perpetration of gross evils consequent upon parental choice.
Nevertheless, whatever the outcome of advice and deliberations,
it should be the firm resolve of all authorities to ensure that the
social, psychological and environmental climate is such that each
individual is enabled to develop its own inherited potentialities to
the fullest extent.
Against the present background of changing attitudes and
patterns of behaviour there can be detected, among responsible
people, an increasing demand for planned families and for fewer
rejected children. This insistence on healthy, successful family life
has, inter alia, stimulated the development of reliable oral contraception
which now enables family planning to take its rightful
place in society and thereby to make its full contribution to the
reduction of genetic hazard.
In the confusion of present and incipient reorganisation of
medical services, the role of the local health authority cannot
remain unaffected. Fortunately, in the field of paediatrics, this
offers greater opportunities for the more recently formed associations
of health visitors and general practitioners to improve
upon the early identification and referral rates with regard to congenital
defects.
Inevitably, times change and we must change with them. It is
unfortunate but the present state of flux in the hospital, medical
and health services generally is leading to some uncertainty about
the health visitor's future status.