Biomedical Ethics and Fetal Therapy

Table of Contents

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List of Tables and Figures

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pp. v-

Foreword

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pp. vii-

Established in 1976, The Calgary Institute for the Humanities has as its aim the fostering of advanced study and research in all areas of the humanities. Apart from supporting work in the traditional "arts" disciplines such as philosophy, history, ancient and modern languages and literatures, it also promotes research into the...

Preface

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pp. ix-

An international group of invited scholars met for two days and provided an authoritative review of the state of the art of all aspects of prenatal diagnosis; they also projected what the future might hold in this rapidly expanding field and explored the legal, moral, and ethical aspects of fetal therapy and experimentation...

List of Contributors

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pp. xi-xii

1. Introduction

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pp. 1-4

New developments in medicine are always born in a nest of technical and ethical issues. The announcement of a development is no sooner made than questions are voiced. Is the new information accurate? Is the new technique effective? Does it do the job it is supposed to do? Does it do this job better than the currently available...

2. Fetal Therapy: State of the Art

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pp. 5-23

The relative impact of congenital disease on perinatal mortality has increased rapidly over the last few years as the standard of perinatal care and neonatal resuscitative events improve. Imaging techniques such as x-rays and amniograms have been useful in the evaluation of fetal anatomy. Currently ultrasound provides visual...

3. Evaluation of Fetal Therapy

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pp. 25-43

In the past decade, a bewildering and increasingly complex array of technologies has been introduced into medical care. In addition to being elegant and sophisticated, these technologies are invariably expensive. In no area is this more true than in obstetrics/gynecology and in neonatology. While the exact portion of health...

4. Ethical Issues in Fetal Therapy Research

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pp. 45-54

In fetal therapy research, it is important to distinguish between pure research, applied research, therapeutic research, innovation, therapy, and treatment-of-resort. Some of these may be called experimental. Societal attitudes towards each of them, in isolation, have reflected a heavy emotional component...

5. Fetal Diagnosis and the Impact of Molecular Genetics

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pp. 55-58

Early in the last decade antenatal genetic diagnosis was introduced primarily as a means of detecting Down's Syndrome and other chromosomal mutations by cytogenetic analysis. Almost immediately the potential for early diagnosis of biochemical diseases became apparent. Those prenatal testing procedures brought with them a...

6. Fetal Therapy: Ethical Considerations

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pp. 59-66

My attention to fetal therapy, awakened several years ago, was recently sharply focused by a report of successful intrauterine treatment of fetal cardiac failure in a twin pregnancy. One twin was an acardiac, acephalic fetus. Ultrasound at twenty-eight weeks revealed notable edema of the trunk in the supporting viable twin, indicating...

7. Management of Pregnancies with Suspected Fetal Anomalies: Clinical Experience and Ethical Issues

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pp. 67-79

In clinical practice, ethical issues frequently arise because of uncertainties. There may be doubts, for example, about the competence of patients, uncertainties about diagnoses, or disagreement about the appropriateness of a particular intervention. In the practice of fetal medicine and surgery, multiple uncertainties appear to be...

8. Fetal Surgery: Establishing the Boundaries of the Unborn Child's Right to Prenatal Care

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pp. 81-105

Recent medical literature indicates that there is a growing number of congenital defects in the fetus that not only can be diagnosed but can also be treated.¹ Many of these are malformations which influence the timing of delivery, since they require correction as soon as possible. They are detectable in utero, but are best...

9. Are Fetuses Becoming Children?

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pp. 107-119

The fetus is becoming a patient, but the moral consequences are not those some commentators suppose. First, patienthood does not imply either personhood or childhood, nor therefore the additional claims persons and children make on us. Moreover, not all patients are equal: some patients take precedence over others, on medical...

10. Summary

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pp. 121-122

The focus on fetal therapy is occurring at a time when there is a shift in perinatal mortality in most countries. Newborn loss from asphyxia is preventable and congenital anomalies are recognizable. Diagnostic aids such as ultrasound offer a window to the fetus and, as a consequence, new problems have been created. These include...