Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Michigan Medicine, Mott Children's Hospital, University of Michigan, Ann Arbor, MI, USA.
Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI, USA.
J Perinatol. 2022 Jul;42(7):971-975. doi: 10.1038/s41372-022-01385-7. Epub 2022 Apr 7.
In our response to, "Parental request for non-resuscitation in fetal myelomeningocele repair: an analysis of the novel ethical tensions in fetal intervention" by Wolfe and co-authors, we argue that parental authority should guide resuscitation decision-making for a fetus at risk for preterm delivery as a complication of fetal myelomeningocele (fMMC) repair. Due to the elevated morbidity and mortality risks of combined myelomeningocele, extreme prematurity, and fetal hypoxia, parents' values regarding the acceptability of possible outcomes should be elicited and their preferences honored. Ethical decision-making in these situations must also consider the broader context of the fetal-maternal dyad. Innovations in fetoscopic approaches to fMMC repair may pose additional complexity to these resuscitation decisions.
在我们对 Wolfe 等人的“父母要求在胎儿脊髓脊膜膨出修复时不进行复苏：胎儿干预中新出现的伦理紧张局势分析”的回应中，我们认为，在胎儿脊髓脊膜膨出修复时因早产而导致胎儿出现危险的情况下，父母的权威应该指导复苏决策。由于合并脊髓脊膜膨出、极度早产和胎儿缺氧的发病率和死亡率较高，应了解父母对可能结果的可接受性的价值观，并尊重他们的偏好。在这些情况下进行伦理决策还必须考虑胎儿-母体对子的更广泛背景。在胎儿镜方法治疗胎儿脊髓脊膜膨出的创新可能会给这些复苏决策带来额外的复杂性。
