van de Vathorst S, Verhagen A A E, Wildschut H I J, Wolf H, Zeeman G G, Lind J
Afd. Ethiek en Filosofie van de Geneeskunde, Erasmus MC-Centrum, Rotterdam.
Ned Tijdschr Geneeskd. 2008 Nov 29;152(48):2589-91.
The recently introduced ultrasonographic screening programme for the detection of fetal structural anomalies at 20 weeks' gestation is leading to a growing number of cases with an unclear prognosis. This article presents the decision-making process which followed the screening of two women: one aged 36 years, where a post-screening work-up was conducted and swiftly led to well-balanced decision making to abort a fetus with trisomy 21, and one woman aged 30 years, in whom repeated non-decisive results of further diagnostic tests ultimately led to a hasty decision to abort the pregnancy. Up to 24 weeks, current Dutch law allows the couple to decide to have a termination of pregnancy; thereafter the legal possibility of having a termination is very limited. This may lead to rushed decision-making. It is argued that careful decisions in these matters are more important than staying within the 24-week limit. The national central committee ofexperts which is responsible for the evaluation of all abortions after 24 weeks gestation in the so-called category 2 cases (conditions which will lead to serious and irreparable functional disorders, such as severe spina bifida and hydrocephalus, but which are compatible with life) should take account of this dilemma ofhaste and caution.
最近推出的在妊娠20周时检测胎儿结构异常的超声筛查计划，导致预后不明的病例越来越多。本文介绍了对两名女性进行筛查后的决策过程：一名36岁女性，筛查后进行了进一步检查，并迅速做出了平衡的决策，终止了患有21三体综合征的胎儿妊娠；另一名30岁女性，进一步诊断测试反复得出非决定性结果，最终仓促决定终止妊娠。在荷兰，直至妊娠24周，夫妻双方都可决定终止妊娠；24周之后，终止妊娠的法律可能性非常有限。这可能导致仓促决策。有人认为，在这些问题上谨慎决策比遵守24周的期限更为重要。负责评估所谓2类病例（即会导致严重且不可修复的功能障碍，如严重脊柱裂和脑积水，但仍可存活的情况）中妊娠24周后所有堕胎情况的国家专家中央委员会，应考虑到这种仓促与谨慎之间的困境。
