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临床胎儿尸检对生殖健康护理的意义:德国背景下的伦理分析

"The significance of clinical foetal autopsy for reproductive health care: an ethical analysis in the German context".

作者信息

Groff Elisa, Cohen Marta C, Steger Florian

机构信息

Institute of the History, Philosophy and Ethics of Medicine, University Hospital Ulm, Ulm, Germany.

Histopathology Department, Sheffield Children'S Hospital NHS, Sheffield, UK.

出版信息

Med Health Care Philos. 2025 Sep;28(3):393-400. doi: 10.1007/s11019-025-10265-8. Epub 2025 Apr 3.

Abstract

The clinical autopsy of foetuses, stillborn babies, or neonates and the examination of the placenta help to inform the mother's decision-making and her medical care for subsequent pregnancies. Indeed, these post-mortem examinations can identify unexpected congenital malformations or the cause of repeated miscarriage or stillbirth. However, the use of clinical pathology for diagnostic purposes in the context of family planning for bereaved parents with an unfulfilled desire to have a child, and IVF couples has received little attention to date. This article applies Beauchamp and Childress' bioethical framework to identify, assess and systematically discuss ethical issues associated with the use of clinical foetal autopsy in reproductive healthcare within the German legal context. In the format of a clinical ethics consultation, the article examines the current policy on perinatal post-mortem examinations in Germany, and asks whether the clinical foetal autopsy for reproductive health purposes should be part of standard clinical examinations offered to bereaved parents. The conclusion of our research recommends clinical foetal autopsy as ethically acceptable, provided that the necessary resources are available. This recommendation is based on the ethical obligation towards the mother as the patient, which is grounded in the bioethical principles of autonomy and beneficence.

摘要

对胎儿、死产儿或新生儿进行临床尸检以及对胎盘进行检查,有助于母亲做出决策并为其后续妊娠提供医疗护理。事实上,这些尸检能够发现意外的先天性畸形或反复流产或死产的原因。然而,在计划生育背景下,对于那些渴望生育却未能如愿的丧亲父母以及体外受精夫妇,将临床病理学用于诊断目的,迄今为止几乎未受到关注。本文运用博尚和奇尔德雷斯的生物伦理框架,在德国法律背景下,识别、评估并系统讨论与在生殖医疗中使用临床胎儿尸检相关的伦理问题。本文以临床伦理咨询的形式,审视了德国围产期尸检的现行政策,并探讨出于生殖健康目的的临床胎儿尸检是否应成为向丧亲父母提供的标准临床检查的一部分。我们的研究结论建议,在有必要资源的情况下,临床胎儿尸检在伦理上是可接受的。这一建议基于对作为患者的母亲的伦理义务,该义务基于自主和行善的生物伦理原则。

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