Department of Obstetrics and Gynecology, Weill Medical College of Cornell University, New York, New York, USA.
Curr Opin Obstet Gynecol. 2010 Apr;22(2):135-8. doi: 10.1097/GCO.0b013e3283374a9f.
First-trimester risk assessment has now become sophisticated and of increasing relevance and applicability to decision-making by pregnant woman about invasive diagnosis. Ethics is an essential dimension of understanding this relevance and applicability. This paper addresses the ethical dimensions of first-trimester risk assessment for trisomy 21.
It is now well established in the ethics and law of the informed consent process that physicians are obligated to offer to patients all medically reasonable alternatives for managing the patient's condition. This disclosure should be guided by the reasonable person standard: the physician should provide clinically important information about the patient's condition or diagnosis, the medically reasonable alternatives for managing it, and the clinical benefits and risks of each such alternative.
On the basis of the ethics of informed consent, we argue that routinely offering first-trimester risk assessment in centers qualified to provide it is ethically obligatory. We describe how pregnant women can be expected to respond to this offer. We then argue that routinely withholding the results of first-trimester risk assessment is ethically unjustified. The ethics of informed consent is an essential dimension of first-trimester risk assessment for trisomy 21.
目前，早孕期风险评估已经变得复杂，并且对于孕妇是否选择侵入性诊断具有越来越重要的意义和适用性。伦理学是理解这种相关性和适用性的一个重要维度。本文讨论了唐氏综合征 21 三体早孕期风险评估的伦理维度。
在知情同意过程的伦理学和法律中，医生有义务向患者提供所有合理的医学选择来管理患者的病情。这种披露应遵循合理人标准：医生应提供关于患者病情或诊断、管理病情的合理医学选择以及每种选择的临床获益和风险的重要信息。
根据知情同意的伦理学，我们认为，在有资格提供这种评估的中心常规提供早孕期风险评估在伦理上是强制性的。我们描述了孕妇可能会如何回应这一要求。然后我们认为，常规地隐瞒早孕期风险评估的结果在伦理上是不合理的。知情同意的伦理学是唐氏综合征 21 三体早孕期风险评估的一个重要维度。
