Letter to the Editor regarding: Brown SD, Ecker JL, Ward JRM, et al

Abstract

Brown and colleagues1Brown S.D. Ecker J.L. Ward J.R.M. et al.Prenatally diagnosed fetal conditions in the age of fetal care: does who counsels matter?.Am J Obstet Gynecol. 2012; 206: 409.e1-409.e11Abstract Full Text Full Text PDF Scopus (27) Google Scholar have done an important service for the perinatal medical community by documenting significant differences of approach to counseling pregnant women regarding the management of a pregnancy complicated by a fetal anomaly. These descriptive ethics data do not establish professional responsibility.2Chervenak F.A. McCullough L.B. Brent R.L. The professional responsibility model of obstetric ethics: avoiding the perils of clashing rights.Am J Obstet Gynecol. 2011; 205: 315.e1-315.e5Abstract Full Text Full Text PDF PubMed Scopus (82) Google Scholar Professional responsibility in such counseling, no matter who provides it, should be guided by the ethical principle of respect for autonomy. This ethical principle obligates the perinatal physician to empower the pregnant woman to make decisions about the management of a previable pregnancy when a fetal anomaly has been reliably diagnosed. We emphasize that the decision is the woman's to make and that counseling should be assiduously nondirective.3Chervenak F.A. McCullough L.B. An ethically justified practical approach to offering, recommending, performing, and referring for induced abortion and feticide.Am J Obstet Gynecol. 2009; 201: 560.e1-560.e6Abstract Full Text Full Text PDF PubMed Scopus (41) Google Scholar The alternatives of continuing pregnancy and termination should both be offered. When there is well-established intervention for fetal benefit, this alternative should also be presented.4Chervenak F.A. McCullough L.B. A comprehensive ethical framework for fetal research and its application to fetal surgery for spina bifida.Am J Obstet Gynecol. 2002; 187: 10-14Abstract Full Text Full Text PDF PubMed Scopus (57) Google Scholar No recommendations should be made, especially about fetal intervention, given its maternal risks for the current and future pregnancies. This nondirective approach should not change for women who reject termination of pregnancy on religious or other moral grounds.3Chervenak F.A. McCullough L.B. An ethically justified practical approach to offering, recommending, performing, and referring for induced abortion and feticide.Am J Obstet Gynecol. 2009; 201: 560.e1-560.e6Abstract Full Text Full Text PDF PubMed Scopus (41) Google Scholar Conscientious counseling about the management of pregnancies complicated by fetal anomalies has been a shared responsibility, with the obstetrician seeking consultation and involvement from other specialties, such as genetics, neonatology, and pediatric surgical and neurologic subspecialties as needed. Progress in improving fetal intervention does not mitigate the obstetrician's role as the primary counselor. This primary role has an important new dimension when fetal care pediatric specialists are involved. The latter need to accept that pediatric ethics, which is based primarily on the best interests of the child standard,5American Academy of Pediatrics Committee on BioethicsInformed consent, parental permission, and assent in pediatric practice.Pediatrics. 1995; 95: 314-317PubMed Google Scholar is not adequate to obstetric ethics, in which beneficence-based obligations to the fetus, when it is a patient (ie, the woman elects to continue her pregnancy), must in all cases be balanced against beneficence-based and autonomy-based obligations to the pregnant patient.2Chervenak F.A. McCullough L.B. Brent R.L. The professional responsibility model of obstetric ethics: avoiding the perils of clashing rights.Am J Obstet Gynecol. 2011; 205: 315.e1-315.e5Abstract Full Text Full Text PDF PubMed Scopus (82) Google Scholar, 3Chervenak F.A. McCullough L.B. An ethically justified practical approach to offering, recommending, performing, and referring for induced abortion and feticide.Am J Obstet Gynecol. 2009; 201: 560.e1-560.e6Abstract Full Text Full Text PDF PubMed Scopus (41) Google Scholar Prenatally diagnosed fetal conditions in the age of fetal care: does who counsels matter?American Journal of Obstetrics & GynecologyVol. 206Issue 5PreviewWe sought to characterize practices and attitudes of maternal-fetal medicine (MFM) and fetal care pediatric (FCP) specialists regarding fetal abnormalities. Full-Text PDF