Ethical considerations in prenatal surgical consultation

The Journal of IMA / Islamic Medical Association of North America, 2011

Fetal malformations complicate approximately 3% of all pregnancies. Many of these are minor or can be corrected after birth, but there are certain malformations that are lethal and others that are severe and others, that, even if corrected lead to permanent disability. Advances in prenatal diagnosis made possible the diagnosis of many fetal malformations. This led to the concept of the fetus a patient, independent of the pregnant woman, even though the moral status of the fetus is in dispute. Many of the lethal malformations are untreatable. However, for some, innovative in utero treatments, both medical and surgical, became possible. These interventions should be evaluated for the relative benefit and risk for both the fetus and the mother, because any such treatment has to involve the integrity of her body. This raises the ethical question of beneficence (to the fetus) versus the autonomy of the pregnant woman. The process of resolving this issue will be discussed, especially how ...

Donald School Journal of Ultrasound in Obstetrics and Gynecology

ongoing pregnancy is bringing up a moral dilemma with emotionally highly challenging issues. The relatively new field of prenatal diagnosis and development of the field of fetomaternal medicine which developed in the last 40 years, requires medical practitioners with extensive training and expensive, highly sophisticated technology. 1 Detection of congenital structural anomalies includes all procedures that lead to the diagnosis and detection of fetal anomalies. For a proper diagnosis-advanced and complex technology is required, as well as, dedicated and well-trained experts are needed to recognize and diagnose the congenital defect. The complexity of the issue is, even more, higher due to the ideological, religious, and social background that in underlying benefit the whole process. In the field of prenatal diagnosis, many ethical, social, and legal questions, conflicts This paper was presented at the symposium Zagreb-New York Ethical and Perinatal Dialogue (1st International Symposium When does human life begin? Ethics, law, and professionalism in reproductive medicine; and Fetal neurology: from shortto the long-term follow-up-how to proceed? Multi-center results on the clinical use of KANET), held on 8

Journal of Indian Association of Pediatric Surgeons, 2006

Obstetrics & Gynecology, 2001

Important clinical, social, and ethical questions are associated with the evaluation and use of surgical approaches aimed at correcting fetal anatomic abnormalities. In particular, the expansion of maternal-fetal surgery to ameliorate nonlethal fetal conditions has intensified the need to address issues about the adequacy of technology assessment and the safety of those who undergo these novel procedures. After discussions at a multidisciplinary conference, we reviewed the development and current practices of maternal-fetal surgery and analyzed the relevant ethical issues concerning the use of maternal-fetal surgery for nonlethal conditions, focusing on the correction of myelomeningocele. Characterizing nonvalidated maternal-fetal surgery procedures as "innovative therapy" blurs the boundaries between research and therapy and creates uncertainty about the obligations of clinicians and researchers. Further, maternal-fetal surgery raises ethical issues related to maternal risks and benefits, informed consent, distinguishing lethal from nonlethal conditions, withholding unproven treatments, entrepreneurship, and prioritization. To help ensure that maternal-fetal surgery will be studied and eventually applied in a scientifically and ethically sound manner, we offer several recommendations. First, innovation in maternal-fetal surgery should be conducted and evaluated as research. Second, women must be considered research subjects in these trials. Third, the informed consent process must ensure adequate comprehension and genuine voluntariness in those considering participation. Fourth, discriminatory and fearful attitudes toward individuals with disabilities should be addressed explicitly prior to making a decision to proceed with maternal-fetal surgery in an attempt to correct such disabilities. Fifth, maternal-fetal surgery should not be performed for cosmetic indications unless and until there is reliable evidence that maternal-fetal surgery can be performed safely and that long-term side effects on women and their offspring are minimal. Sixth, centers of excellence should be established for conducting research and providing maternal-fetal surgery. Seventh, funding for research on maternal-fetal surgery should be considered in the context of societal needs.

Journal of Medical Ethics, 2011

Fetal surgery has been practised for some decades now. However, it remains a highly complex area, both medically and ethically. This paper shows how the routine use of ultrasound has been a catalyst for fetal surgery, in creating new needs and new incentives for intervention. Some of the needs met by fetal surgery are those of parents and clinicians who experience stress while waiting for the birth of a fetus with known anomalies. The paper suggests that the role of technology and visualisation techniques in creating and meeting such new needs is ethically problematic. It then addresses the idea that fetal surgery should be restricted to interventions that are life-saving for the fetus, arguing that this restriction is unduly paternalistic. Fetal surgery poses challenges for an autonomy-based system of ethics. However, it is risky to circumvent these challenges by restricting the choices open to pregnant women, even when these choices appear excessively altruistic.

Pediatrics, 2017

The ethics of maternal-fetal surgery involves weighing the importance of potential benefits, risks, and other consequences involving the pregnant woman, fetus, and other family members. We assessed clinicians' ratings of the importance of 9 considerations relevant to maternal-fetal surgery. This study was a discrete choice experiment contained within a 2015 national mail-based survey of 1200 neonatologists, pediatric surgeons, and maternal-fetal medicine physicians, with latent class analysis subsequently used to identify groups of physicians with similar ratings. Of 1176 eligible participants, 660 (56%) completed the discrete choice experiment. The highest-ranked consideration was of neonatal benefits, which was followed by consideration of the risk of maternal complications. By using latent class analysis, we identified 4 attitudinal groups with similar patterns of prioritization: "fetocentric" (n = 232), risk-sensitive (n = 197), maternal autonomy (n = 167), and fam...

Acta Paediatrica, 2008

Something new is happening in perinatal health care. Many leading children's hospitals are creating fetal care centers as part of the continuum of care that they offer. We, and others, call this the paediatrics-based model of fetal-care. This is in contrast to the obstetrics-based model that offers traditional care to pregnant women and fetuses and has traditionally been the domain of obstetrics services.

American Journal of Perinatology, 2014

Fetal diagnosis has raised ethical issues since it was first developed in the 1940s and 1950s. Two controversial issues have predominated. First, when the techniques for prenatal diagnosis were invasive techniques, they created risks to the pregnant women. Second, prenatal diagnosis led to either prenatal treatment, which also generally had some risks to the pregnant woman, or to abortion, which has always been ethically controversial. In this article, we will review the history of ethical controversy over fetal diagnosis and discuss how they presage today's controversies.

Facts, views & vision in ObGyn, 2011

The pregnant patient is a vulnerable subject, and even more so when a serious fetal condition is diagnosed. (Invasive) fetal therapy should only be offered when there is a good chance that the life of the fetus will be saved, or irreversible damage by the disease or disability is prevented. Following diagnosis of a potentially treatable condition, the patient needs to be referred to a center with sufficient expertise in diagnosis and all therapeutic options. Preferences of the physician towards one or another antenatal intervention is not at stake prior to that moment. When fetal therapy is justified--, it should be offered with full respect for maternal choice and individual assessment and perception of potential-- risks, and should be at the location where there is sufficient expertise. For therapies of unproven benefit, the absence of evidence must be disclosed, and therapy should only be undertaken with full voluntary consent of the mother. These ought to be undertaken within we...

1998

Evaporation flux from wall surfaces can be estimated quantitatively by measuring the temperature which depends in a sensitive way on the evaporation rate.' When the equilibrium condition is reached the temperature of surfaces where evaporation takes place is in fact directly correlated to the evaporation rate and it depends on several concomitant heat exchange processes. On the other hand starting from non-equilibrium initial condition the "dynamic" measurement of wall surface temperature as a function of time allows the evaluation of water content in the surface layers. In the Archaeometry laboratory of "lstituto di Fisica Generale Applicata" we performed some experiments on several plaster samples among the ones most traditionally used. We employed a climatic room where environmental parameters (temperature, RH, ventilation and irradiation) are controlled and cooling effects due to evaporation are investigated by thermography both in steady and unsteady condjtions.