Ethical issues in the management of pregnancies complicated by fetal anomalies.
ABSTRACT Ethics is an essential dimension of the clinical management of pregnancies complicated by fetal anomalies. Utilizing the ethical principles of beneficence and respect for autonomy, this review first sets out the ethical concept of the fetus as a patient. This concept provides the basis for a comprehensive approach to ethical issues in the management of pregnancies complicated by fetal anomalies. Practical, ethically justified guidance is given for the physician's role in counseling pregnant women about aggressive management, termination of pregnancy, selective termination of multifetal pregnancies, nonaggressive management, cephalocentesis, and fetal research.
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ABSTRACT: The ethical issues behind the management of a fetus with a serious abnormality and the decisions made in relation to the outcome of the pregnancy are complex. This reflective paper deals with the ethical principles of managing a pregnancy with a congenital anomaly, with particular emphasis on the fetus with a serious cardiac abnormality. One major ethical concern is whether the fetus is or is not independent being to whom obligations of beneficence are owed. We review the debate on this matter, and suggest that it is ethically more appropriate for physicians who are involved in management of fetal abnormality not to adopt and insist on their own position on this matter. Rather, the appropriate course is to respect the pregnant woman's own view of her fetus and how it should be regarded. This is an application of the principle of respect for autonomy. Within this framework, we discuss the difficulties in counselling a pregnant woman or expectant couple in this situation, and recommend three key steps in ethically sound counselling.International Journal of Pediatrics 01/2010; 2010:857460.
Article: Pregnancy and Protection: The Ethics of Limiting a Pregnant Woman's Participation in Clinical Trials.[show abstract] [hide abstract]
ABSTRACT: The call for the inclusion of pregnant women in clinical trials has received renewed attention recently. This interest springs from articles in various medical journals highlighting the gaps in medical knowledge and the need to improve health care for pregnant women.It is not a simple decision whether to include pregnant women in studies or not. The general thought is that it's too dangerous for the baby if a pregnant woman is participating in a trial, and the absence of research on how medications work in pregnant women leave doctors guessing about how to safely and effectively treat patients through pregnancy.Excluding pregnant women from clinical trials are not automatic, not unethical nor is it arbitrarily determined. The regulatory framework is based on sound ethical and legal reasoning that demonstrates when inclusion in a clinical trial is appropriate or when clear and compelling reasons for exclusion are presented. LEARNING OBJECTIVE: Readers will learn about limitations of research, history of the inclusion and exclusion of pregnant women in clinical trials, reticence for inclusions, as well as regulations designed using reasoned legal and ethical principles, such as: Principle of Autonomy, Informed Consent, and Beneficence and Nonmaleficence.Journal of clinical research & bioethics. 03/2011; 2(108).