The practice of caring for a pregnant woman and her fetus has always had the dual goal of good outcome for both parties. Furthermore, the pregnant woman has always had to consider undergoing risks or discomforts for the sake of her fetus. With recent advances in perinatal medicine, the pregnant woman and her fetus are increasingly viewed as two treatable patients.1 The fetus is less surrounded in mystery and is more accessible to diagnostic procedures and treatment in utero. The area of fetal evaluation and therapy has created a variety of ethical questions.
Decisions concerning fetal therapy have several important aspects. The field of fetal medical and surgical treatment is new and evolving at such a rapid rate that most techniques involving fetal intervention are clouded in more uncertainty than is the case for many other therapeutic decisions. Some fetal therapeutic interventions, such as intrauterine transfusion or cesarean delivery for placenta previa, are standard practices of proven efficacy. Other interventions, such as cesarean delivery for fetal distress, are routine practices but have a more ambiguous data base upon which to make decisions. Still other fetal interventions, such as shunt diversions for hydrocephalus or obstructive uropathy, are considered research procedures and are not standard medical practices. An international registry has been established to record experience with these experimental surgical interventions.2
Although decisions concerning a fetus require surrogate decision makers, as in the case of infants and children, decisions by pregnant women concerning their fetuses involve more than considerations of the best interests of their offspring.
- Copyright © 1988 by the American Academy of Pediatrics