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Prenatal screening for Down's syndrome and other chromosomal anomalies has become common obstetrical practice. The purpose of this intervention is to provide women with the information needed to make informed reproductive choices. It is assumed that the ethical beliefs of parents play an important role in decision-making about whether to undergo testing, but little is known about their precise significance. More insight into how women conceptualize their choice of using prenatal screening tests may clarify the impact of personal ethical beliefs. With this aim, we conducted qualitative research consisting of semi-structured interviews with 59 women in the Netherlands who were offered a prenatal screening test. The analysis showed that the ethical views between acceptors and decliners showed similar diversity. In contrast with the currently accepted view, we conclude that ethical beliefs are one of the factors implicated in the decision. Women decide about prenatal testing by balancing the information provided by the test against the risks of further investigation, the emotional burden of a disabled child on their well-being and life perspective, as well as on those of family members. Normative moral principles are introduced once the choice is made, namely as factors in justifying and supporting the decision. [Copyright &y& Elsevier]

Health Technology Assessment (HTA) uses explicit methods to determine the value of a health technology. This typically results in several claims regarding the effects that are expected to follow from the use of a health technology in a particular context. These claims seem to capture conclusions based solely on facts, but they often combine empirical information with normative presuppositions. Claims that have this character reflect (implicit) value judgments and have been labelled mixed claims. Not recognizing these normative components of such claims risks value inattention and value imposition , presenting results as self-evident and not in need of any moral justification. As proposed by Anna Alexandrova, to avoid these risks of value inattention and imposition we need rules to deal with mixed claims. According to her, when producing and evaluating mixed claims we need to unearth the invoked value presuppositions and check whether these presuppositions are invariant to disagreements. By applying these rules, the robustness of mixed claims can be checked: it can be evaluated whether their truth value is independent from the way in which their components, involving normative presuppositions, are conceptualized. This paper aims to illustrate the role of mixed claims in HTA, and expand upon the work by Alexandrova, by analyzing claims and recommendations presented in an HTA report on the introduction of Non-Invasive Prenatal Testing (NIPT) in The Netherlands. Our results show that the report contains mixed claims, and that a normative analysis of these claims can help to clarify the normativity of HTA and evaluate the robustness of claims on alleged effects of a health technology. • HTA examines claims on potential effects of health technology. • Conceptualizing these effects may invoke value judgments. • Causal claims invoking value judgments have been described as mixed claims. • We analyzed mixed claims in an HTA report on Non-Invasive Prenatal Testing. • This showed that normative analysis helps evaluating the robustness of these claims. [ABSTRACT FROM AUTHOR]