Pediatric Hospice and Palliative Medicine, University of Kansas Medical Center, Kansas City, KS, USA.
Children's Mercy Hospital & Clinics, Bioethics Center and Division of Neonatology, Kansas City, MO, USA.
Semin Fetal Neonatal Med. 2018 Feb;23(1):35-38. doi: 10.1016/j.siny.2017.09.001. Epub 2017 Sep 13.
The perinatal world is unique in its dutiful consideration of two patients along the lines of decision-making and clinical management - the fetus and the pregnant woman. The potentiality of the fetus-newborn is intertwined with the absolute considerations for the woman as autonomous patient. From prenatal diagnostics, which may be quite extensive, to potential interventions prenatally, postnatal resuscitation, and neonatal management, the fetus and newborn may be anticipated to survive with or without special needs and technology, to have a questionable or guarded prognosis, or to live only minutes to hours. This review will address the ethical ramifications for prenatal diagnostics, parental values and goals clarification, birth plans, the fluidity of decision-making over time, and the potential role of prenatal and postnatal palliative care support.
围产期的世界是独特的，它沿着决策和临床管理的两条线，尽责地考虑两个患者——胎儿和孕妇。胎儿-新生儿的潜能与妇女作为自主患者的绝对考虑因素交织在一起。从可能非常广泛的产前诊断，到潜在的产前干预、新生儿复苏和新生儿管理，胎儿和新生儿可能有生存的可能，也可能有特殊的需求和技术，预后可能不确定或令人担忧，也可能只能存活几分钟到几个小时。这篇综述将探讨产前诊断的伦理影响、父母的价值观和目标澄清、生育计划、决策随时间的变化、以及产前和产后姑息治疗支持的潜在作用。
