Published online April 3, 2006
PEDIATRICS Vol. 117 No. 4 April 2006, pp. 1382-1387 (doi:10.1542/peds.2004-2724)
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SPECIAL ARTICLE

Do Differences in the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists Positions on the Ethics of Maternal–Fetal Interventions Reflect Subtly Divergent Professional Sensitivities to Pregnant Women and Fetuses?

Stephen D. Brown, MDa, Robert D. Truog, MDb, Judith A. Johnson, JDc and Jeffrey L. Ecker, MDd

a Department of Radiology, Children's Hospital, Boston, Massachusetts
b Division of Critical Care Medicine, Children's Hospital, and Division of Medical Ethics, Harvard Medical School, Boston, Massachusetts
c Office of Ethics, Children's Hospital, Boston, Massachusetts
d Vincent Memorial Obstetric Service, Massachusetts General Hospital, Boston, Massachusetts

As therapeutic interventions that are designed for the direct benefit of the fetus have evolved, pediatric specialists along with obstetricians have become increasingly engaged in the management of pregnancies that are complicated by fetal disorders. Do the 2 groups of medical specialists hold differing "world views" on the nature of the maternal–fetal relationship that could have an impact on decision-making? A direct comparison of the positions of the ethics committees of the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists concerning maternal–fetal conflicts and fetal therapy reveals subtle but telling differences. Compared with the American College of Obstetricians and Gynecologists policy, the American Academy of Pediatrics statement accords somewhat less weight to maternal decision-making and is more tolerant of overriding maternal refusal of interventions that are recommended for fetal benefit. In doing so, it may oblige pregnant patients to assume greater risk and tolerate diminished autonomy. We urge leaders from both disciplines to meet and seek consensus so that a common approach and language can guide treatment of the patients whom we share.

Key Words: ethics • perinatal medicine • pregnancy • professional attitudes • prenatal care

Abbreviations: AAP—American Academy of Pediatrics • ACOG—American College of Obstetricians and Gynecologists • PKU—phenylketonuria

Accepted Sep 8, 2005.