An ethically justified, clinically comprehensive management strategy for third-trimester pregnancies complicated by fetal anomalies

Article Abstract:

Advanced technology enables fetal malformations to be detected early. When fetal anomalies are detected before 24 weeks of pregnancy, termination of pregnancy is a legal therapeutic option. However, termination of pregnancies complicated by fetal anomalies that are detected after 24 weeks is difficult to obtain. To help direct medical management strategies, a movement has surfaced to consider the fetus in the last three months of pregnancy as a patient. An ethically sound, clinically comprehensive management plan has been developed to deal with fetal anomalies detected in the third trimester of pregnancy. Seventy-two pregnancies diagnosed with fetal anomalies after the 24th week of pregnancy were divided into three categories: aggressive management, which involves maximizing the outcome of the fetus without compromising the mother; nonaggressive management, which focuses on preserving maternal health and abandoning efforts to benefit the fetus; and termination of pregnancy, which reduces maternal health risks and is considered less risky than aggressive management. Three women (4 percent) were offered both nonaggressive management and pregnancy termination, 18 (25 percent) were offered aggressive and nonaggressive management and 51 were offered aggressive management. Management recommendations were based on requirements of informed consent procedures and a detailed ethical description of the diagnosis and probable outcome of the fetus. It was concluded that termination of pregnancy or nonaggressive management should be recommended when there was no beneficence-based obligation to the fetus. A choice between aggressive and nonaggressive management should be offered when a minimal beneficence-based obligation to the fetus is present. Termination of pregnancy and nonaggressive management are not recommended for fetuses having more than minimal beneficence-based obligations; only aggressive management is recommended for this group of fetuses. (Consumer Summary produced by Reliance Medical Information, Inc.)

Abnormalities, Fetus, Abortion

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Non aggressive obstetric management: an option for some fetal anomalies during the third trimester

Article Abstract:

Recently invented obstetric instruments and techniques allow the detection of many problems of fetal growth and development, including severe fetal anomalies. The medical profession has generally responded to the knowledge of severe and adverse conditions of the fetus either by terminating the pregnancy or by the administration of aggressive medical treatment. In some cases, this may have emerged from the concept that the third-trimester fetus is a living being and therefore a patient. An area which has not recently been addressed with much ardor is the area of nonaggressive management of the third-trimester pregnancy when there is (1) a high level of confidence in the diagnosis of anomaly, and (2) death or severe impairment of intelligence is the likely outcome. The ethics of this situation are discussed and the legitimacy of nonaggressive obstetric management of such third-trimester pregnancies is defended. Two approaches to obstetric ethics are outlined that both argue for the reasonableness of nonaggressive management in cases of fetal anomalies that satisy the two above criteria. Techniques for intelligently allowing the autonomy of the pregnant woman are explored. Down's syndrome, a condition caused by an extra chromosome, is clearly not included in this definition and these cases should be managed aggressively.

Research, Case studies, Prenatal diagnosis, Obstetrical research

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Withdrawing Very Low-Burden Interventions in Chronically Ill Patients

Article Abstract:

It may be ethical to disconnect a demented patient's pacemaker if the patient's living will supports such a decision. The patient may have refused all extraordinary measures in the living will but may have had strong feelings about committing suicide. However, there is a distinction between withholding and withdrawing a treatment. Disconnecting a pacemaker would change the time of death but the act of disconnecting it would not be lethal.

Terminal care, Refusal to treat (Medicine)

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