Department of Pediatrics, Division of Neurology, Connecticut Children's, University of Connecticut, Farmington, CT, USA.
NeuroDevelopmental Science Center, Akron Children's Hospital, Akron, OH, USA.
Dev Med Child Neurol. 2023 Jul;65(7):900-907. doi: 10.1111/dmcn.15528. Epub 2023 Feb 2.
The aim of this review was to discuss bioethics in prenatal diagnosis and health care after recent legislative and judicial changes affecting reproductive rights, such as the repeal of 'Roe v. Wade' in the United States. We recognize that abortion involves particular moralities that are not universal or shared by all cultures, groups, and individuals. We reviewed the historical aspects of embryology and personhood, fetal morbidity and mortality, and parental options for prenatal diagnostic testing. We examined relevant ethical issues including informed consent, the emergence of fetal pain, reproductive autonomy, the fiduciary responsibilities of pregnant mothers, and the obligations of physicians caring for the maternal-fetal dyad. The code of medical ethics includes respect for decisional privacy and the protection of information shared in confidence. When a fetal anomaly is diagnosed, pregnant mothers must be informed about the risks, burdens, and alternatives in either continuing or terminating the pregnancy. Parental choice should include the right to refuse testing, the informed choice not to know about certain genetic test results, and the right to make informed decisions about the best interests of the future child. In the diagnosis and care of fetal anomalies, moral dilemmas arise. Before fetal viability, the mother's autonomy, sense of beneficence, and personal values should be trusted and respected. Perinatal palliative care should be available to pregnant mothers whose anomalous fetus is carried to birth.
本综述旨在讨论产前诊断中的生物伦理学问题，以及最近影响生殖权利的立法和司法变革，如美国“罗诉韦德案”的废除。我们认识到，堕胎涉及到特殊的道德问题，这些道德问题并非所有文化、群体和个人都普遍认同或共同认可。我们回顾了胚胎学和人格、胎儿发病率和死亡率以及产前诊断检测的父母选择的历史方面。我们研究了相关的伦理问题，包括知情同意、胎儿疼痛的出现、生殖自主权、孕妇的受托责任以及为母婴对子提供护理的医生的义务。医学伦理准则包括尊重决策隐私和保护机密信息的共享。当诊断出胎儿异常时，必须告知孕妇有关继续或终止妊娠的风险、负担和替代方案。父母的选择应包括拒绝检测的权利、知情选择不了解某些基因检测结果的权利以及对未来孩子最佳利益做出知情决策的权利。在胎儿异常的诊断和护理中，会出现道德困境。在胎儿有生存能力之前，应信任和尊重母亲的自主权、行善意识和个人价值观。应向携带异常胎儿出生的孕妇提供围产期姑息治疗。
