52 results on '"Fetal Therapies ethics"'
Search Results
2. [Maternal-fetal therapy: from saving the fetus towards a better life for the future child].
- Author
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Verweij EJ, van der Hout S, Lopriore E, Oepkes D, and Dondorp WJ
- Subjects
- Child, Counseling methods, Female, Fetal Therapies methods, Fetus, Humans, Pregnancy, Pregnancy Complications therapy, Counseling ethics, Decision Making ethics, Fetal Diseases therapy, Fetal Therapies ethics, Prenatal Care ethics
- Abstract
Maternal-fetal therapy (MFT) is special because treatment of the fetus is exclusively possible through the body of another person, the pregnant woman. MFT is a broad specialty with diverse interventions. In this manuscript several examples of innovations in MFT are discussed to illustrate the shift of lifesaving interventions to interventions aiming to improve morbidity of the future child. The broadening of the scope and shift towards prenatal treatments improving morbidity result in new ethical challenges. Particularly attention is needed for counseling and (the risk of) therapeutic misconception.
- Published
- 2021
3. Professionally responsible management of the ethical and social challenges of antenatal screening and diagnosis of β-thalassemia in a high-risk population.
- Author
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Corda V, Murgia F, Dessolis F, Murru S, Chervenak FA, McCullough LB, and Monni G
- Subjects
- Directive Counseling ethics, Female, Fetal Therapies ethics, Fetal Therapies methods, Genetic Testing ethics, Humans, Italy, Patient Participation, Pregnancy, Prenatal Diagnosis methods, Risk, Socioeconomic Factors, beta-Thalassemia genetics, beta-Thalassemia therapy, Patient Acceptance of Health Care, Prenatal Diagnosis ethics, Professional-Patient Relations ethics, Social Determinants of Health, beta-Thalassemia diagnosis
- Abstract
Thalassemias are among the most frequent genetic disorders worldwide. They are an important social and economic strain in high-risk populations. The benefit of β-thalassemia screening programs is growing evident but the capacity to diagnose fetal β-thalassemia exceeds the treatment possibilities and even when treatment before birth becomes feasible, difficult decisions about the relative risks will remain. This paper can be of practical and ethically justified aid when counseling women about screening, diagnosis, and treatment of β-thalassemia. It takes in consideration various social challenges, medical issues such as antenatal screening, preimplantation genetic diagnosis, prenatal diagnosis, non-invasive prenatal testing and prenatal therapy. We also describe the Sardinian experience in applying and promoting high-risk population screening and diagnosis programs and future trends in the management of β-thalassemia., (© 2021 Walter de Gruyter GmbH, Berlin/Boston.)
- Published
- 2021
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4. Prenatal treatment of severe congenital diaphragmatic hernia: there is still medical equipoise.
- Author
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Deprest J
- Subjects
- Female, Fetal Therapies methods, Humans, Pregnancy, Fetal Therapies ethics, Hernias, Diaphragmatic, Congenital embryology
- Published
- 2020
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5. The ethics of ectogenesis-aided foetal treatment.
- Author
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Segers S, Pennings G, and Mertes H
- Subjects
- Beneficence, Female, Humans, Moral Obligations, Personal Autonomy, Pregnancy ethics, Ectogenesis ethics, Fetal Therapies ethics, Fetus, Pregnant Women
- Abstract
In this paper, we aim to stimulate ethical debate about the morally relevant connection between ectogenesis and the foetus as a potential beneficiary of treatment. Ectogenesis could facilitate foetal interventions by treating the foetus independently of the pregnant woman and provide easier access to the foetus if interventions are required. The moral relevance hereof derives from the observation that, together with other developments in genetic technology and prenatal treatment, this may catalyse the allocation of a patient status to the foetus. The topic of foetal medicine is of growing interest to clinicians, and it also deserves due attention from an ethical perspective. To the extent that these developments contribute to the allocation of a patient status to the foetus (and to its respective interests for medical treatment), normative questions arise about how moral responsibilities towards foetal interests should be balanced against the interests of the pregnant woman. We conclude that, even if ectogenesis could facilitate foetal therapy, it is important to remain sensitive to the fact that it would not circumvent the key ethical concerns that come with in utero foetal treatment and that it may even exacerbate potential conflicts between directive treatment recommendations and the pregnant woman's autonomous decision to the contrary., (© 2020 John Wiley & Sons Ltd.)
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- 2020
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6. Anesthesia for Fetal Surgery and Fetal Procedures.
- Author
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Ring LE and Ginosar Y
- Subjects
- Analgesics, Opioid therapeutic use, Cesarean Section methods, Female, Fetal Therapies ethics, Fetal Viability, Fetoscopy methods, Gestational Age, Humans, Injections, Intramuscular, Minimally Invasive Surgical Procedures methods, Needles, Neuromuscular Blocking Agents therapeutic use, Placental Circulation physiology, Pregnancy physiology, Surgery, Computer-Assisted, Anesthesia, Conduction methods, Anesthesia, General methods, Anesthetics therapeutic use, Fetal Diseases surgery, Fetal Therapies methods, Fetus surgery
- Abstract
Advances in imaging and technique have pushed the boundaries of the types of surgical interventions available to fetuses with congenital and developmental abnormalities. This review focuses on fundamental aspects of fetal anesthesia, including the physiologic changes of pregnancy, uteroplacental perfusion, and fetal physiology. We discuss the types of fetal surgeries and procedures currently being performed and discuss the specific anesthetic approaches to different categories of fetal surgeries. We also discuss ethical aspects of fetal surgery and anesthesia., (Copyright © 2019 Elsevier Inc. All rights reserved.)
- Published
- 2019
- Full Text
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7. [To act or not to act? Developments in prenatal and postnatal care for children with spina bifida aperta].
- Author
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Lutters BTH, Spoor JKH, de Jong THR, Kompanje EJO, Verhagen AAE, Brouwer OF, and Groen RJM
- Subjects
- Humans, Infant, Newborn, Postnatal Care, Prenatal Care, Quality of Life, Abortion, Eugenic ethics, Euthanasia, Active ethics, Fetal Therapies ethics, Spina Bifida Cystica therapy
- Abstract
To act or not to act? Developments in prenatal and postnatal care for children with spina bifida aperta Until the middle of the twentieth century, newborns with spina bifida aperta had low chances of survival. Advances in the treatment of hydrocephalus, among other conditions, led to increased chances of survival during the 1960s. This also revealed the downsides of the treatment of spina bifida patients since some considered the quality of life of a number of these patients to be unacceptable. But withholding treatment also had negative consequences, leading to an ethical deadlock. Over the past thirty years - besides postnatal closure of the neural tube defect - more emphasis has been put on selective pregnancy termination and sporadic active termination of life in newborns with very severe forms of spina bifida. At the same time, new treatment strategies, such as foetal surgery, are being developed. With this historical overview, we illustrate the way in which technological developments and ethical dilemmas are constantly affecting each other.
- Published
- 2019
8. Amnioinfusions to Treat Early Onset Anhydramnios Caused by Renal Anomalies: Background and Rationale for the Renal Anhydramnios Fetal Therapy Trial.
- Author
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O'Hare EM, Jelin AC, Miller JL, Ruano R, Atkinson MA, Baschat AA, and Jelin EB
- Subjects
- Anuria epidemiology, Anuria therapy, Female, Fetal Diseases therapy, Fetal Therapies ethics, Humans, Kidney embryology, Kidney Diseases epidemiology, Kidney Diseases genetics, Lung embryology, Pregnancy, Anuria complications, Fetal Therapies methods, Kidney abnormalities, Kidney Diseases therapy
- Abstract
Anhydramnios caused by early anuria is thought to be universally fatal due to pulmonary hypoplasia. Bilateral renal agenesis and early fetal renal failure leading to anhydramnios constitute early pregnancy renal anhydramnios (EPRA). There have been successful reports of amnioinfusions to promote lung growth in the setting of EPRA. Some of these successfully treated EPRA fetuses have survived the neonatal period, undergone successful dialysis, and subsequently received a kidney transplant. Conversely, there are no reports of untreated EPRA survivors. This early success of amnioinfusions to treat EPRA justifies a rigorous prospective trial. The objective of this study is to provide a review of what is known about fetal therapy for EPRA and describe the Renal Anhydramnios Fetal Therapy trial. We review the epidemiology, pathophysiology, and genetics of EPRA. Furthermore, we have performed systematic review of case reports of treated EPRA. We describe the ethical framework, logistical challenges, and rationale for the current single center (NCT03101891) and planned multicenter trial., (© 2019 S. Karger AG, Basel.)
- Published
- 2019
- Full Text
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9. Fetal interventional procedures and surgeries: a practical approach.
- Author
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Nassr AA, Erfani H, Fisher JE, Ogunleye OK, Espinoza J, Belfort MA, and Shamshirsaz AA
- Subjects
- Congenital Abnormalities therapy, Female, Fetal Diseases diagnosis, Fetal Diseases therapy, Fetal Therapies ethics, Fetal Therapies trends, Fetoscopy methods, Humans, Infant, Newborn, Pain Management methods, Perinatal Care methods, Pregnancy, Ultrasonography, Interventional, Ultrasonography, Prenatal, Fetal Therapies methods
- Published
- 2018
- Full Text
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10. The ethics of maternal-fetal surgery.
- Author
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Chervenak FA and McCullough LB
- Subjects
- Female, Humans, Pregnancy, Ethics, Medical, Fetal Therapies ethics, Fetus surgery
- Abstract
Maternal-fetal surgery is performed on two patients, the pregnant patient and the fetal patient. Ethics is therefore an essential dimension of maternal-fetal surgery. From its beginnings in only a few centers, various procedures have become available in highly specialized centers in developed countries. Innovation and research have played an indispensable role in the development of maternal-fetal surgery and will continue to do so. In this article we present ethically justified criteria, based on the ethical concept of the fetus as a patient, for clinical innovation and research of maternal-fetal surgery and for the professionally responsible transition from innovation and research into clinical practice. These criteria are designed to be used by clinical innovators, clinical investigators, and by oversight committees., (Copyright © 2017 Elsevier Ltd. All rights reserved.)
- Published
- 2018
- Full Text
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11. Responsible surgical innovation and research in maternal-fetal surgery.
- Author
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Antiel RM and Flake AW
- Subjects
- Ethics, Medical, Humans, Biomedical Research, Fetal Therapies ethics
- Abstract
The field of maternal-fetal intervention is rapidly evolving with new technologies and innovations. This raises complex ethical and medico-legal challenges related to what constitutes innovative treatment versus human experimentation, with or without the umbrella of "medical research." There exists a gray zone between these black and white classifications, but there are also clear guidelines that should be responsibly negotiated when making the essential transition between an innovative treatment and a validated therapy. This review attempts to define some of the current and future ethical challenges in maternal-fetal research, and to offer constructive insight into how they might be addressed., (Copyright © 2017 Elsevier Ltd. All rights reserved.)
- Published
- 2017
- Full Text
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12. Ethical issues in fetal therapy.
- Author
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Moaddab A, Nassr AA, Belfort MA, and Shamshirsaz AA
- Subjects
- Counseling, Female, Humans, Pregnancy, Prenatal Diagnosis, Congenital Abnormalities therapy, Decision Making, Fetal Therapies ethics, Ultrasonography, Prenatal
- Abstract
The introduction of routine fetal ultrasound and the technical improvements in ultrasound equipment have greatly increased our ability to diagnose fetal anomalies. As a consequence, congenital anomalies are diagnosed today earlier and in a greater number of patients than ever before. The development of fetal intervention and fetal surgery techniques, improved anesthesia methodology, and sophisticated perinatal care at the limits of viability, have now made prenatal management of some birth defects or fetal malformations a reality. The increasing number of indications for fetal therapy and the apparent desire of parents to seek out these procedures have raised concern regarding the ethical issues related to the therapy. While fetal therapy may have a huge impact on the prenatal management of some congenital birth defects and/or fetal malformations, because of the invasive nature of these procedures, the lack of sufficient data regarding long-term outcomes, and the medical/ethical uncertainties associated with some of these interventions there is cause for concern. This chapter aims to highlight some of the most important ethical considerations pertaining to fetal therapy, and to provide a conceptual ethical framework for a decision-making process to help in the choice of management options., (Copyright © 2017. Published by Elsevier Ltd.)
- Published
- 2017
- Full Text
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13. Management of Congenital Diaphragmatic Hernia in Newborn - Paradigm Shift and Ethical Issues.
- Author
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Bhatnagar SN and Sarin YK
- Subjects
- Extracorporeal Membrane Oxygenation, Fetal Therapies ethics, Fetal Therapies methods, Fetus surgery, Hernias, Diaphragmatic, Congenital complications, Hernias, Diaphragmatic, Congenital diagnosis, Humans, Hypertension, Pulmonary etiology, Infant, Newborn, Prenatal Diagnosis ethics, Prenatal Diagnosis methods, Respiration, Artificial, Hernias, Diaphragmatic, Congenital surgery
- Abstract
Management of congenital diaphragmatic hernia (CDH) begins soon after it is detected, whether antenatally or postnatally. Assessment of the severity of the condition, associated congenital anomalies, maternal health and related issues, weight of the fetus/baby, mode of delivery, timing of delivery, immediate appropriate management of the baby with CDH at birth, appropriate utilization of available treatment modalities as well as infrastructure of the treating institute have an impact on the outcome of the neonate. Survival without significant long-term/permanent morbidity is considered as good outcome. With advances in antenatal diagnosis, several legal and ethical considerations have cropped up. While on one hand there are proponents of early antenatal diagnosis and medical termination of pregnancy (MTP), on the other hand there are several socio-cultural groups who look upon human life as precious and argue against MTP. There is an ongoing ethical battle between maternal vs. fetal rights; there is no way to put a lid on the controversy whether the mother be allowed to choose in favor of MTP after being aware of the anomalous fetus or, we must attempt to save every fetus irrespective of the antenatal diagnosis of life-threatening anomalies. Notwithstanding, appropriate assessment of the condition, thorough counseling and sound evidence-based decisions could avert ethical dilemma in most cases. This review article provides information about the various choices available in the diagnostic and treatment armamentarium, though it should be kept in mind that the entire spectrum of management strategies may not be universally available.
- Published
- 2017
- Full Text
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14. Maternal-fetal surgery for myelomeningocele: some thoughts on ethical, legal, and psychological issues in a Western European situation.
- Author
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Van Calenbergh F, Joyeux L, and Deprest J
- Subjects
- Europe, Female, Fetus abnormalities, Fetus surgery, Humans, Pregnancy, Fetal Diseases surgery, Fetal Therapies ethics, Fetal Therapies methods, Fetal Therapies psychology, Jurisprudence, Meningomyelocele surgery
- Abstract
Background: The results of the Management of Myelomeningocele Study (MOMS) randomized controlled trial have demonstrated that maternal-fetal surgery (MFS) for myelomeningocele (MMC) compared to postnatal MMC repair has clear neurological benefits for the child at 12 and 30 months of age. Level I evidence nevertheless does not provide answers to many questions in this delicate field. Since the beginning of 2012, our fetal center has been offering MFS for spina bifida aperta (SBA) to patients from different European and non-European countries, in a societal context where termination of pregnancy is the option chosen by most patients when being informed of this diagnosis., Methods: We aim to explore in this text some of the ethical, legal, and psychological issues that we have encountered., Results: For many of these questions, we do not have definite answers. A pregnant patient when diagnosed with a MMC fetus is a vulnerable subject. She needs to be referred to a highly specialized center with sufficient expertise in diagnosis and in all therapeutic options. Objective but compassionate counseling is of paramount importance. It is required that a multidisciplinary professional team obtains full voluntary consent from the mother after providing an appropriate information including diagnosis, short-, medium-, and long-term prognosis as well as benefits and harms of the fetal surgery., Conclusion: The latter should be offered with full respect for maternal choice and individual assessment and perception of potential risks taking into consideration legislation in the fetal center and the parents' country legislation.
- Published
- 2017
- Full Text
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15. Maternal risks of fetal therapy.
- Author
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Al-Refai A, Ryan G, and Van Mieghem T
- Subjects
- Adult, Congenital Abnormalities, Directive Counseling, Female, Fetal Diseases diagnosis, Fetal Diseases psychology, Gestational Age, Humans, Maternal Mortality, Pregnancy, Pregnancy Complications diagnosis, Pregnancy Complications psychology, Prenatal Diagnosis, Risk Factors, Treatment Outcome, Fetal Diseases surgery, Fetal Therapies ethics, Fetal Therapies methods, Fetal Therapies mortality, Minimally Invasive Surgical Procedures ethics, Minimally Invasive Surgical Procedures methods, Minimally Invasive Surgical Procedures mortality, Postoperative Complications mortality, Pregnancy Complications surgery, Pregnant Women psychology
- Abstract
Purpose of Review: Although most fetal disorders can be treated after birth, a few conditions that predictably lead to fetal or neonatal death, or that progress significantly before birth, are ideally treated prenatally. The number of centers offering fetal therapeutic procedures is gradually increasing worldwide. Patients and caregivers should be aware of the potential maternal risks of these interventions., Recent Findings: For transplacental medical therapy (corticosteroids, antiarrhythmics and immunoglobulins), severe maternal adverse events are rare, when done in expert centers. Minimally invasive procedures carry a risk of maternal complications of about 5%, with 1% being severe complications (pulmonary edema or placental abruption). Open fetal surgery carries important risks to the mother, both in the index pregnancy (pulmonary edema, placental abruption, chorioamnionitis and scar dehiscence) and in subsequent pregnancies (uterine rupture), yet some of these risks are decreasing with surgical refinement and increasing experience of the surgical team., Summary: The information in this manuscript provides a base to counsel expectant mothers on risk of fetal therapy.
- Published
- 2017
- Full Text
- View/download PDF
16. Fetal therapy for Down syndrome: an ethical exploration.
- Author
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de Wert G, Dondorp W, and Bianchi DW
- Subjects
- Animals, Cognition physiology, Disease Models, Animal, Down Syndrome diagnosis, Down Syndrome psychology, Female, Fetal Therapies methods, Humans, Infant, Newborn, Mice, Pregnancy, Down Syndrome therapy, Fetal Therapies ethics
- Abstract
Background: Parallel to recent advances in prenatal screening for Down syndrome (DS), therapies for different aspects of the condition have become available. As intellectual disability is a key aspect, this is an active area for research. Several groups have hypothesized that prenatal interventions will give better chances at improving cognitive functioning in persons with DS than postnatal treatment. Clinical trials are being developed., Method: We first discuss the ethical pros and cons of trying to improve cognitive functioning in persons with DS to see if there are categorical objections to the general idea, and then move on to explore ethically relevant aspects of the prospect of developing fetal therapy for DS (FTDS)., Results: Only on the basis of a one-dimensional emphasis on the social model of disability would (fetal) therapy aimed at cognitive improvement be inherently problematic., Conclusions: Inviting pregnant women to participate in FTDS-research should be based on adequate pre-clinical trials, as well as information aimed at avoiding the so-called 'therapeutic misconception'. Should FTDS be proven to be effective and safe, women carrying a fetus with trisomy 21 who have decided to continue the pregnancy may have a moral obligation to make use of this option. © 2016 John Wiley & Sons, Ltd., (© 2016 John Wiley & Sons, Ltd.)
- Published
- 2017
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17. Better Parenting through Biomedical Modification: A Case for Pluralism, Deference, and Charity.
- Author
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Wasserman D
- Subjects
- Bioethics, Female, Humans, Male, Principle-Based Ethics, Choice Behavior ethics, Congenital Abnormalities prevention & control, Fetal Therapies ethics, Genetic Enhancement ethics, Morals, Parenting psychology
- Abstract
In this paper, I will argue that the moral assessment of the prenatal selection and postnatal modification biotechnologies requires a nuanced approach, which pays close attention to the variety of sometimes conflicting parental roles and reasons involved in decisions for and against their use. I will focus on several related but distinct reasons that parents have, or give, for modifying existing children or selecting future children. Many of these reasons are expressed in terms of more effective parenting. Because there is a plurality of legitimate parental goals, I will conclude that assessing parental interventions requires us to adjudicate conflicts or tradeoffs among those goals.
- Published
- 2017
- Full Text
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18. Healthcare justice and human rights in perinatal medicine.
- Author
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Chervenak FA and McCullough LB
- Subjects
- Child, Ethical Analysis, Female, Humans, Personal Autonomy, Pregnancy, Decision Making ethics, Ethics, Medical, Fetal Therapies ethics, Fetal Viability physiology, Human Rights, Informed Consent ethics, Perinatal Care ethics, Social Justice ethics
- Abstract
This article describes an approach to ethics of perinatal medicine in which "women and children first" plays a central role, based on the concept of healthcare justice. Healthcare justice requires that all patients receive clinical management based on their clinical needs, which are defined by deliberative (evidence-based, rigorous, transparent, and accountable) clinical judgment. All patients in perinatal medicine includes pregnant, fetal, and neonatal patients. Healthcare justice also protects the informed consent process, which is intended to empower the exercise of patient autonomy in the decision-making process about patient care. In the context of healthcare justice, the informed consent process should not be influenced by ethically irrelevant factors. Healthcare justice should be understood as a basis for the human rights to healthcare and to participate in decisions about one's healthcare. Healthcare justice in perinatal medicine creates an essential role for the perinatologist to be an effective advocate for pregnant, fetal, and neonatal patients, i.e., for "women and children first.", (Copyright © 2016 Elsevier Inc. All rights reserved.)
- Published
- 2016
- Full Text
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19. Ethics and social acceptability of a proposed clinical trial using maternal gene therapy to treat severe early-onset fetal growth restriction.
- Author
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Sheppard M, Spencer RN, Ashcroft R, and David AL
- Subjects
- Europe, Female, Fetal Growth Retardation genetics, Fetal Therapies methods, Genetic Therapy methods, Humans, Pregnancy, Uterine Artery, Vascular Endothelial Growth Factor A genetics, Vascular Endothelial Growth Factor A therapeutic use, Clinical Trials as Topic ethics, Fetal Growth Retardation therapy, Fetal Therapies ethics, Genetic Therapy ethics
- Abstract
Objective: To evaluate the ethical and social acceptability of a proposed clinical trial using maternal uterine artery vascular endothelial growth factor (VEGF) gene therapy to treat severe early-onset fetal growth restriction (FGR) in pregnant women., Methods: We conducted a literature review on the ethics and legality of experimental treatments in pregnant women, in particular advanced therapeutics. Issues that were identified from the literature helped develop interview guides for semistructured, qualitative interviews, carried out in four European countries, with 34 key stakeholders (disability groups, professional bodies and patient support groups) and 24 women/couples who had experienced a pregnancy affected by severe early-onset FGR., Results: The literature review identified two main questions: 'is it ethical to give a pregnant woman a potentially risky treatment from which she does not benefit directly?' and 'is it ethical to treat a condition of the unborn child, who may then be born with a serious disability when, without treatment, they would have died?'. The review concluded that there were no ethical or legal objections to the intervention, or to a trial of this intervention. Overall, respondents viewed the proposed trial in positive terms. Women were generally interested in participating in clinical trials that conferred a potential benefit to their unborn child. The risk of disability of the premature child was a concern, but not considered a major stumbling block for maternal VEGF gene therapy., Conclusions: This study did not identify any fundamental or insurmountable objections to a trial of maternal gene therapy for severe early-onset FGR. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd., (Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.)
- Published
- 2016
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20. [Foetal therapy for Down syndrome: a pro-active ethical reflection].
- Author
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de Wert GM and Dondorp WJ
- Subjects
- Down Syndrome diagnosis, Female, Fetal Therapies ethics, Genetic Testing methods, Humans, Personal Autonomy, Pregnancy, Down Syndrome therapy, Ethics, Medical, Fetal Therapies methods, Prenatal Diagnosis methods
- Abstract
Prenatal screening for Down syndrome has to date focused on facilitating the informed choice to continue or not with a pregnancy. The non-invasive prenatal test (NIPT) for Down syndrome does potentially offer the option to apply foetal neurocognitive therapy for Down syndrome (FTDS). Current research in animal models looks promising and therefore a proactive ethical reflection in relation to clinical trials is urgently needed. This discussion includes an exploration of the ethical aspects of FTDS. There seem to be no convincing a priori objections on the basis of the social model of disability. Arguments in terms of (respect for) autonomy, wellbeing and justice seem to in principle support such therapy. Still, both the conditions for sound clinical trials and the implications of possible effective therapy for current prenatal screening need further scrutiny.
- Published
- 2016
21. Stem cell transplantation before birth - a realistic option for treatment of osteogenesis imperfecta?
- Author
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Westgren M and Götherström C
- Subjects
- Female, Fetal Therapies ethics, Humans, Mesenchymal Stem Cell Transplantation ethics, Osteogenesis Imperfecta diagnosis, Pregnancy, Prenatal Diagnosis, Treatment Outcome, Fetal Therapies methods, Mesenchymal Stem Cell Transplantation methods, Osteogenesis Imperfecta therapy
- Abstract
Osteogenesis imperfecta (OI) is characterized by severe bone deformities, growth retardation and bones that break easily, often from little or no apparent cause. OI is a genetic disorder primarily with defective type I collagen with a wide spectrum of clinical expression. In the more severe cases, it can be diagnosed before birth. Transplantation of mesenchymal stem cells (MSC) has the potential to improve the bone structure and stability, growth and fracture healing. Prenatal and postnatal cell transplantation has been investigated in preclinical and clinical studies of OI and suggests that this procedure is safe and has positive effects. Cell transplantation resulted in improved linear growth, mobility and reduced fracture incidence. However, the effect is transient and for this reason re-transplantation may be needed. So far there is limited experience in this area, and proper studies are required to accurately determine if MSC transplantation is of clinical benefit in the treatment of OI. In this review, we summarize what is currently known in this field., (© 2015 John Wiley & Sons, Ltd.)
- Published
- 2015
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22. Fetal endocrine therapy for congenital adrenal hyperplasia should not be done.
- Author
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Miller WL
- Subjects
- Adrenal Hyperplasia, Congenital complications, Dexamethasone therapeutic use, Female, Fetal Therapies ethics, Glucocorticoids therapeutic use, Humans, Infant, Low Birth Weight, Infant, Newborn, Male, Pregnancy, Virilism etiology, Adrenal Hyperplasia, Congenital drug therapy, Cognition Disorders chemically induced, Dexamethasone adverse effects, Fetal Diseases drug therapy, Fetal Therapies adverse effects, Glucocorticoids adverse effects, Virilism prevention & control
- Abstract
Prenatal treatment of congenital adrenal hyperplasia by administering dexamethasone to a woman presumed to be carrying an at-risk fetus remains a controversial experimental treatment. Review of data from animal experimentation and human trials indicates that dexamethasone cannot be considered safe for the fetus. In animals, prenatal dexamethasone decreases birth weight, affects renal, pancreatic beta cell and brain development, increases anxiety and predisposes to adult hypertension and hyperglycemia. In human studies, prenatal dexamethasone is associated with orofacial clefts, decreased birth weight, poorer verbal working memory, and poorer self-perception of scholastic and social competence. Numerous medical societies have cautioned that prenatal treatment of adrenal hyperplasia with dexamethasone is not appropriate for routine clinical practice and should only be done in Institutional Review Board approved, prospective clinical research settings with written informed consent. The data indicate that this treatment is inconsistent with the classic medical ethical maxim to 'first do no harm'., (Copyright © 2015 Elsevier Ltd. All rights reserved.)
- Published
- 2015
- Full Text
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23. Ethical issues in fetal diagnosis and treatment.
- Author
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McMann CL, Carter BS, and Lantos JD
- Subjects
- Ethics, Medical, Female, History, 20th Century, Humans, Hypoplastic Left Heart Syndrome diagnosis, Meningomyelocele diagnosis, Pregnancy, Prenatal Diagnosis history, Fetal Therapies ethics, Hypoplastic Left Heart Syndrome surgery, Meningomyelocele surgery, Prenatal Diagnosis ethics
- Abstract
Fetal diagnosis has raised ethical issues since it was first developed in the 1940s and 1950s. Two controversial issues have predominated. First, when the techniques for prenatal diagnosis were invasive techniques, they created risks to the pregnant women. Second, prenatal diagnosis led to either prenatal treatment, which also generally had some risks to the pregnant woman, or to abortion, which has always been ethically controversial. In this article, we will review the history of ethical controversy over fetal diagnosis and discuss how they presage today's controversies., (Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.)
- Published
- 2014
- Full Text
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24. Ethics of prenatal ultrasound.
- Author
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Howe D
- Subjects
- Abortion, Eugenic ethics, Congenital Abnormalities therapy, Ethics, Medical, Female, Fetal Diseases therapy, Fetal Therapies ethics, Humans, Patient Preference, Pregnancy, Congenital Abnormalities diagnostic imaging, Fetal Diseases diagnostic imaging, Ultrasonography, Prenatal ethics
- Abstract
Prenatal ultrasound has opened new opportunities to examine, diagnose and treat the fetus, but these advances bring with them ethical dilemmas. In this chapter, I address the ethical principles that need to be considered when treating both mother and fetus as patients, and how these can be applied in practice. In particular, ultrasound practitioners have an ethical duty to maintain their theoretical knowledge and practical skills to ensure they advise parents correctly. I also discuss the ethical issues in carrying out intrauterine therapy, ultrasound-related research, and termination of pregnancy for fetal abnormality., (Copyright © 2013 Elsevier Ltd. All rights reserved.)
- Published
- 2014
- Full Text
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25. Prenatal treatment of congenital adrenal hyperplasia: risks outweigh benefits.
- Author
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Miller WL and Witchel SF
- Subjects
- Animals, Dexamethasone therapeutic use, Female, Fetal Therapies ethics, Glucocorticoids therapeutic use, Humans, Male, Practice Guidelines as Topic, Pregnancy, Pregnancy Trimester, First, Adrenal Hyperplasia, Congenital drug therapy, Dexamethasone adverse effects, Fetal Therapies adverse effects, Glucocorticoids adverse effects, Pregnancy Complications chemically induced, Prenatal Exposure Delayed Effects chemically induced
- Abstract
Prenatal treatment of congenital adrenal hyperplasia by administering dexamethasone to a woman presumed to be carrying an at-risk fetus has been described as safe and effective in several reports. A review of data from animal experimentation and human trials indicates that first-trimester dexamethasone decreases birthweight; affects renal, pancreatic beta cell, and brain development; increases anxiety; and predisposes to adult hypertension and hyperglycemia. In human studies, first-trimester dexamethasone is associated with orofacial clefts, decreased birthweight, poorer verbal working memory, and poorer self-perception of scholastic and social competence. Numerous medical societies have cautioned that prenatal treatment of congenital adrenal hyperplasia with dexamethasone should only be done in prospective clinical research settings with institutional review board approval, and therefore is not appropriate for routine community practice., (Copyright © 2013 Mosby, Inc. All rights reserved.)
- Published
- 2013
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26. Anesthesia for in utero repair of myelomeningocele.
- Author
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Ferschl M, Ball R, Lee H, and Rollins MD
- Subjects
- Adult, Analgesia, Female, Fetus physiology, Gestational Age, Humans, Intraoperative Care, Meningomyelocele diagnostic imaging, Postoperative Care, Pregnancy, Prenatal Diagnosis, Preoperative Care, Spinal Dysraphism diagnostic imaging, Ultrasonography, Anesthesia methods, Fetal Therapies ethics, Fetus surgery, Meningomyelocele surgery, Spinal Dysraphism surgery
- Abstract
Recently published results suggest that prenatal repair of fetal myelomeningocele is a potentially preferable alternative when compared to postnatal repair. In this article, the pathology of myelomeningocele, unique physiologic considerations, perioperative anesthetic management, and ethical considerations of open fetal surgery for prenatal myelomeningocele repair are discussed. Open fetal surgeries have many unique anesthetic issues such as inducing profound uterine relaxation, vigilance for maternal or fetal blood loss, fetal monitoring, and possible fetal resuscitation. Postoperative management, including the requirement for postoperative tocolysis and maternal analgesia, are also reviewed. The success of intrauterine myelomeningocele repair relies on a well-coordinated multidisciplinary approach. Fetal surgery is an important topic for anesthesiologists to understand, as the number of fetal procedures is likely to increase as new fetal treatment centers are opened across the United States.
- Published
- 2013
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27. Advances in fetal genetic diagnosis and therapy: ethical issues and appropriate technology in cost-restrained countries.
- Author
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Titus MJ and Moodley J
- Subjects
- Developing Countries, Female, Fetal Diseases genetics, Fetal Diseases therapy, Genetic Testing ethics, Humans, Informed Consent, Pregnancy, Prenatal Diagnosis methods, Fetal Diseases diagnosis, Fetal Therapies ethics, Personal Autonomy, Prenatal Diagnosis ethics
- Abstract
The advent of ultrasound in the 1970s heralded a milestone that could give real-time information about fetal abnormalities, and thereby improve diagnostic accuracy. This knowledge could not be used effectively to benefit the fetus for which it was intended. The 1980s saw science catching up with diagnostic advances, and fetal abnormalities could realistically be treated with an expectation of satisfactory outcomes. As a result, parents could have realistic expectations of having healthy children. Prenatal diagnosis is the first step towards this realisation, as diagnosis can be followed by intrauterine treatment. Scientists have realised that, if an abnormality can be corrected prenatally, prognosis can be improved significantly, as the initial problem does not necessarily threaten the fetus; therefore, if the prenatal condition can be dealt with early, then the downstream repercussions can be eliminated. In this chapter, we address ethical issues in prenatal diagnosis and fetal therapy., (Copyright © 2012 Elsevier Ltd. All rights reserved.)
- Published
- 2012
- Full Text
- View/download PDF
28. Ethical issues in the diagnosis and management of fetal disorders.
- Author
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Chadwick R and Childs R
- Subjects
- Abortion, Induced, Ethics, Medical, Female, Fetal Diseases genetics, Fetal Diseases therapy, Genetic Diseases, Inborn diagnosis, Genetic Diseases, Inborn therapy, Humans, Pregnancy, Fetal Diseases diagnosis, Fetal Therapies ethics, Genetic Testing ethics, Genetic Therapy ethics, Personal Autonomy, Prenatal Diagnosis ethics
- Abstract
The ethics of diagnosis and management of fetal genetic disorders are particularly controversial because of the contested status of the fetus and perceptions of genetics. An additional complicating factor is the potential conflict between mother and fetus. Ethical issues in diagnosis include the nature and purpose of the diagnosis itself, and management of the information. Management of the disorder includes issues of termination as an option, and the emerging field of fetal gene therapy with associated issues of somatic versus germ-line interventions., (Copyright © 2012 Elsevier Ltd. All rights reserved.)
- Published
- 2012
- Full Text
- View/download PDF
29. Foetal cardiac intervention: an ethical perspective.
- Author
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Mavroudis CD
- Subjects
- Female, Fetal Therapies methods, Humans, Infant, Newborn, Pregnancy, Pregnancy Outcome, Prenatal Diagnosis, Cardiac Surgical Procedures, Ethics, Medical, Fetal Therapies ethics, Heart Defects, Congenital diagnosis, Heart Defects, Congenital embryology, Heart Defects, Congenital surgery
- Abstract
Although recent advances have helped identify cases where foetal cardiac surgery might reverse the development of certain lesions, the indications and measurement of success in these procedures have yet to be established. Thus, both patients and physicians have a "burden of knowledge", whereby a diagnosis is made without a clear course of action. The profound issues raised by foetal intervention, specifically the question of how concepts such as "patient" and "success" can be used, complicate this burden further and test the limits of language and logic. Similar issues raised in postmodern philosophy are discussed and can be incorporated into foetal cardiac surgery dialogues to produce a multi-disciplinary approach that will elucidate, not obfuscate, these issues in the future.
- Published
- 2011
- Full Text
- View/download PDF
30. Legal and ethical issues in fetal surgery.
- Author
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Dickens BM and Cook RJ
- Subjects
- Ethics, Medical, Female, Fetal Therapies ethics, Humans, Infant Welfare, Infant, Newborn, Life, Meningomyelocele surgery, Patient Education as Topic, Pregnancy, Spinal Dysraphism surgery, United States, Fetal Diseases surgery, Fetal Therapies methods, Legislation, Medical
- Abstract
Recent research in the USA has shown the advantages for children's welfare of open fetal surgery over postnatal treatment for myelomeningocele. However, a balance must be struck between complications of premature birth risked by prenatal surgery and the long-term advantages for affected children's health, including mobility and neurologic capacity. Risks for women are repeated surgery for intervention and delivery. The research raises legal and ethical questions about how fetal interests should influence women's choices, and whether women may decline interventions in their pregnancies that offer their children lifelong advantages. Beyond fetal interests and women's preferences are state interests in fetal life, which in the USA and elsewhere have been expressed in judicially authorized cesarean deliveries. Underlying issues are the nature of fetal interests; contrasting entitlements to care from their mothers of fetuses and born children; healthcare providers' responsibilities toward fetuses; and duties of care, information, and advice to pregnant women., (Copyright © 2011 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.)
- Published
- 2011
- Full Text
- View/download PDF
31. Ethical guidelines regarding interventions for fetal wellbeing.
- Subjects
- Female, Humans, Informed Consent, Pregnancy, Ethics, Medical, Fetal Therapies ethics, Human Rights
- Published
- 2011
- Full Text
- View/download PDF
32. Fetal therapy: progress made and lessons learnt.
- Author
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Nicolaides KH and Chitty LS
- Subjects
- Education, Medical, Continuing trends, Evidence-Based Practice trends, Female, Fetal Therapies ethics, Fetal Therapies history, History, 20th Century, Humans, Minimally Invasive Surgical Procedures trends, Neonatology ethics, Neonatology standards, Neonatology trends, Pregnancy, Pregnancy Complications epidemiology, Pregnancy Complications etiology, Pregnancy Complications therapy, Fetal Therapies methods, Fetal Therapies trends
- Published
- 2011
- Full Text
- View/download PDF
33. Fetal therapy: practical ethical considerations.
- Author
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Ville Y
- Subjects
- Abortion, Eugenic statistics & numerical data, Attitude of Health Personnel, Congenital Abnormalities psychology, Congenital Abnormalities therapy, Female, Fetal Therapies statistics & numerical data, Fetal Therapies trends, Humans, Pregnancy, Uncertainty, Ethics, Medical, Fetal Therapies ethics, Fetal Therapies methods
- Abstract
Progress in prenatal diagnosis can lead to the diagnosis of severe fetal abnormalities for which natural history anticipates a fatal outcome or the development of severe disability despite optimal postnatal care. Intrauterine therapy can be offered in these selected cases. Prenatal diagnosis is the only field of medicine in which termination is an option in the management of severe diseases. Fetal therapy has therefore developed as an alternative to fatalist expectant prenatal management as well as to termination of pregnancy (TOP). There are few standards of fetal care that have gone beyond the stage of equipoise and even fewer have been established based on appropriate studies comparing pre- and postnatal care. Several ethical questions are being raised as fetal surgery develops, including basic Hippocratic principles of patients' autonomy and doctors' duty of competence moving the boundaries between experimental surgery, therapeutic innovation and standard care. In addition, the technical success of a fetal intervention can only rarely fully predict the postnatal outcome. Managing uncertainty regarding long-term morbidity and the possibility for fetal therapy to change the risk of perinatal death into that of severe handicap remains a critical factor affecting women's choice for TOP as an alternative to fetal therapy., (Copyright © 2011 John Wiley & Sons, Ltd.)
- Published
- 2011
- Full Text
- View/download PDF
34. Current controversies in prenatal diagnosis 1: is stem cell therapy ready for human fetuses?
- Author
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Mummery C, Westgren M, and Sermon K
- Subjects
- Consensus, Contraindications, Dissent and Disputes, Female, Fetal Therapies ethics, Fetal Therapies methods, Humans, Pregnancy, Prenatal Diagnosis methods, Regenerative Medicine ethics, Regenerative Medicine methods, Regenerative Medicine trends, Stem Cell Transplantation ethics, Stem Cell Transplantation methods, Fetal Therapies trends, Prenatal Diagnosis trends, Stem Cell Transplantation statistics & numerical data
- Published
- 2011
- Full Text
- View/download PDF
35. Genetic engineering to avoid genetic neglect: from chance to responsibility.
- Author
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Hammond J
- Subjects
- Disabled Persons, Female, Human Rights, Humans, Infant, Personhood, Pregnancy, Child Abuse ethics, Fetal Therapies ethics, Genetic Diseases, Inborn prevention & control, Genetic Engineering ethics, Moral Obligations
- Abstract
Currently our assessment of whether someone is a good parent depends on the environmental inputs (or lack of such inputs) they give their children. But new genetic intervention technologies, to which we may soon have access, mean that how good a parent is will depend also on the genetic inputs they give their children. Each new piece of available technology threatens to open up another way that we can neglect our children. Our obligations to our children and our susceptibilities to corresponding legal and moral sanctions may be about to explosively increase. In this paper I argue that we should treat conventional neglect and 'genetic neglect' - failing to use genetic intervention technologies to prevent serious diseases and disabilities - morally consistently. I conclude that in a range of cases parents will have a moral obligation to use genetic treatments to prevent serious disabilities in their children. My particular focus is on prenatal interventions and their impact of the bodily integrity of expectant mothers. I conclude that although bodily integrity constrains moral obligations, it is outweighed in a range of cases.
- Published
- 2010
- Full Text
- View/download PDF
36. Fetal gene therapy: opportunities and risks.
- Author
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Wagner AM, Schoeberlein A, and Surbek D
- Subjects
- Female, Fetal Therapies adverse effects, Fetal Therapies ethics, Gene Transfer Techniques, Genetic Therapy adverse effects, Genetic Therapy ethics, Genetic Vectors, Hematopoietic Stem Cell Transplantation adverse effects, Humans, Mesenchymal Stem Cell Transplantation adverse effects, Pregnancy, Risk, Fetal Diseases therapy, Fetal Therapies methods, Genetic Diseases, Inborn therapy, Genetic Therapy methods
- Abstract
Advances in human prenatal medicine and molecular genetics have allowed the diagnosis of many genetic diseases early in gestation. In-utero transplantation of allogeneic hematopoietic stem cells (HSC) has been successfully used as a therapy in different animal models and recently also in human fetuses. Unfortunately, clinical success of this novel treatment is limited by the lack of donor cell engraftment in non-immunocompromised hosts and is thus restricted to diseases where the fetus is affected by severe immunodeficiency. Gene therapy using genetically modified autologous HSC circumvents allogeneic HLA barriers and constitutes one of the most promising new approaches to correct genetic deficits in the fetus. Recent developments of strategies to overcome failure of efficient transduction of quiescent hematopoietic cells include the use of new vector constructs and transduction protocols. These improvements open new perspectives for gene therapy in general and for prenatal gene transfer in particular. The fetus may be especially susceptible for successful gene therapy due to the immunologic naiveté of the immature hematopoietic system during gestation, precluding an immune reaction towards the transgene. Ethical issues, in particular those regarding treatment safety, must be taken into account before clinical trials with fetal gene therapy in human pregnancies can be initiated.
- Published
- 2009
- Full Text
- View/download PDF
37. [Recent developments in fetal surgery. Technical, organizational and ethical considerations].
- Author
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Ville Y
- Subjects
- Analgesia methods, Cesarean Section, Clinical Trials as Topic ethics, Diseases in Twins, Ethics Committees, Clinical, Female, Fetal Diseases diagnosis, Fetal Therapies ethics, Fetal Therapies instrumentation, Fetal Therapies methods, Fetoscopy, France, Hernia, Diaphragmatic embryology, Hernia, Diaphragmatic surgery, Hernias, Diaphragmatic, Congenital, Humans, Hypoplastic Left Heart Syndrome embryology, Hypoplastic Left Heart Syndrome surgery, Hysterotomy, Infant, Newborn, Laparotomy, Meningomyelocele embryology, Meningomyelocele surgery, Perinatology organization & administration, Pregnancy, Pregnancy, Multiple, Prenatal Diagnosis methods, Pulmonary Valve Stenosis embryology, Pulmonary Valve Stenosis surgery, Twins, Monozygotic, Fetal Diseases surgery, Fetal Therapies trends
- Abstract
Progress in prenatal diagnosis has led to more frequent detection of fetal abnormalities which, if left untreated, would be fatal or cause severe disabilities despite optimal postnatal care. Intrauterine surgery is possible in selected cases. Most procedures involve microendoscopy with local or regional analgesia. Fetal analgesia is indicated for procedures that are directly invasive for the fetus. Surgical treatment of twin-to-twin transfusion is so far the only example of successful fetal therapy, as demonstrated in a randomized controlled trial. The most severe forms of congenital diaphragmatic hernia may also benefit from temporary occlusion of the fetal trachea in order to allow lung growth and prevent pulmonary hypoplasia. The future of open fetal surgery will depend partly on the results of the ongoing MOM study of intrauterine coverage of myelomeningocele. These developments also raise ethical questions, including the competence of the surgical team, and the borderline between therapeutic innovation, experimental surgery, and standard of care. The possibility of therapeutic termination should not be overlooked.
- Published
- 2008
38. Ethical considerations of fetal therapy.
- Author
-
Noble R and Rodeck CH
- Subjects
- Fetal Therapies adverse effects, Fetal Therapies methods, Genetic Therapy adverse effects, Genetic Therapy ethics, Genetic Therapy methods, Humans, Informed Consent ethics, Patient Selection ethics, Therapeutic Human Experimentation ethics, Ethics, Clinical, Fetal Diseases therapy, Fetal Therapies ethics
- Abstract
Fetal therapy raises ethical concerns in relation to the balance of potential benefit and harm, autonomy and informed consent, and the duties of the clinician to the pregnant women and fetus. Invasive therapy should be recommended only when it has a realistic chance of saving the life of the fetus and offspring or preventing serious and irreversible disease or disability. Clinicians should respect maternal choice and assessment of risk, particularly if the therapy might be only partially successful, leaving the offspring with a profound morbidity. Fetal therapy should not be undertaken without maternal consent; nor should it be presented coercively as an option to avoid a termination of pregnancy. Therapeutic procedures of unproven efficacy should be undertaken only with the voluntary informed consent of the pregnant woman and according to a clearly defined research protocol that has been approved by an appropriate research ethics committee and where appropriate support and counselling can be provided.
- Published
- 2008
- Full Text
- View/download PDF
39. Technical and ethical issues in fetal therapy.
- Author
-
Ville Y
- Subjects
- Female, Humans, Pregnancy, Ethics, Medical, Fetal Therapies ethics
- Published
- 2007
- Full Text
- View/download PDF
40. On the nature, assessment, and treatment of fetal pain: neurobiological bases, pragmatic issues, and ethical concerns.
- Author
-
Gupta A and Giordano J
- Subjects
- Analgesia ethics, Analgesia methods, Central Nervous System anatomy & histology, Central Nervous System embryology, Central Nervous System physiology, Consciousness, Ethics, Medical, Female, Humans, Pain physiopathology, Prenatal Diagnosis ethics, Fetal Diseases physiopathology, Fetal Diseases prevention & control, Fetal Therapies ethics, Pain prevention & control, Pregnancy ethics
- Abstract
Over the past 2 decades, the issue of fetal pain and stress has attracted considerable attention and has become the focus of ongoing debate in light of advances in medical diagnostics and technology that allow invasive prenatal medical intervention(s), and an enhanced understanding of fetal neurophysiology, together with a broadened appreciation for the relationship of brain and consciousness. In this essay, we explore the issue of fetal pain based upon knowledge of both the ontogeny and function of the nervous system and the interaction of brain, mind, and pain. We posit that contemporary understanding of neurological development fortifies appreciation that pain sensation and perception occurs during (later) fetal life and that this pain warrants clinical consideration during the conduct of invasive prenatal procedures. We present differing perspectives on this issue, discuss the relative merits and difficulties of these positions, and ultimately describe the fundamental basis for a consideration of fetal pain and address this consideration with regard to pragmatic and ethical benefits, burdens, and risks. We adopt a neurocentric, yet consilient approach that entails both scientific and philosophical orientations. By attempting to reveal inherent limitations in our contemporary appreciation and approach(es) to fetal pain, we hope to illustrate the need for and posit potential venues toward resolving these limitations and dilemmas.
- Published
- 2007
41. An ethically justified, clinically comprehensive approach to peri-viability: gynaecological, obstetric, perinatal and neonatal dimensions.
- Author
-
Chervenak FA, McCullough LB, and Levene MI
- Subjects
- Female, Humans, Infant, Newborn, Pregnancy, Abortion, Induced ethics, Fetal Therapies ethics, Fetal Viability, Life Support Care ethics, Perinatal Care ethics
- Abstract
Peri-viability, 22-26 completed weeks' gestational age, has generated ongoing clinical ethical controversies concerning the roles of abortion, caesarean delivery for fetal indication, neonatal resuscitation and limits on life-sustaining treatment of neonates. This paper provides a comprehensive, ethically justified approach to the clinical management of peri-viable fetuses and infants. We reviewed available data about the outcomes of peri-viable fetuses and developed an outcomes-based ethical framework that appeals to the ethical principles of beneficence, autonomy and justice. We identified beneficence-based, autonomy-based and justice-based considerations that should guide clinical judgement, the informed consent process, and decisions about termination of pregnancy, caesarean delivery and setting justified limits on life-sustaining treatment of neonatal patients. Ethics is an essential component of perinatal medicine because it provides physicians with an evidence-based, ethically justified, comprehensive approach to the gynaecological, obstetric, perinatal and neonatal dimensions of peri-viability.
- Published
- 2007
- Full Text
- View/download PDF
42. Intra-partum transvaginal cranial decompression of intracranial teratoma.
- Author
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Pachydakis A, Belgaumkar PV, and Patel R
- Subjects
- Adult, Decompression, Surgical ethics, Female, Humans, Pregnancy, Vagina surgery, Brain Neoplasms surgery, Decompression, Surgical methods, Fetal Diseases surgery, Fetal Therapies ethics, Teratoma surgery
- Published
- 2007
- Full Text
- View/download PDF
43. Medicine. Desperate measures.
- Author
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Couzin J
- Subjects
- Cardiac Surgical Procedures adverse effects, Female, Fetal Therapies adverse effects, Fetal Therapies ethics, Fetoscopy adverse effects, Hernia, Diaphragmatic surgery, Humans, Pregnancy, Randomized Controlled Trials as Topic, Surgical Procedures, Operative adverse effects, Surgical Procedures, Operative ethics, Fetal Diseases surgery, Fetus surgery, Heart Defects, Congenital surgery, Hernias, Diaphragmatic, Congenital, Spinal Dysraphism surgery
- Published
- 2006
- Full Text
- View/download PDF
44. Dilemmas in fetal medicine: premature application of technology or responding to women's choice?
- Author
-
Williams C
- Subjects
- Abortion, Legal, Choice Behavior, Counseling, Female, Fetus surgery, Hospital Units, Humans, Interviews as Topic, London, Nurse Midwives ethics, Nurse Midwives psychology, Obstetrics trends, Pregnancy, Prenatal Care ethics, Reproductive Medicine trends, Specialization, Ultrasonography, Prenatal, Attitude of Health Personnel, Fetal Therapies ethics, Fetus abnormalities, Maternal-Fetal Relations, Obstetrics ethics, Reproductive Medicine ethics, Women's Health
- Abstract
It is argued that innovative health technologies (IHTs) may be changing the roles of both patients and health practitioners, and raising new issues, including ethical, legal and social dilemmas. This paper focuses on the innovative area of fetal medicine. All fetal treatment necessitates accessing the fetus through the pregnant woman's body, and non-surgical treatments have long been a part of pregnancy care. However, recent developments in this area, including the increasing routinisation of sophisticated antenatal ultrasound screening and the introduction of treatments including fetal surgery, may mark a shift in this specialty. The paper explores such shifts from the perspectives of medical and midwifery practitioners working in two Fetal Medicine Units. It examines the apparent effects of the orientation of fetal medicine on prevalent conceptualisations of the maternal-fetal relationship, and some of the consequences of this. It is argued that new forms of uncertainty, including complex risk and diagnostic information, and uncertain prognostic predictions set within the rhetoric of non-directive counselling and women's choice, are leading to unprecedented ethical dilemmas within this area. More widespread debate about such potential dilemmas needs to take place before, rather than following their introduction.
- Published
- 2006
- Full Text
- View/download PDF
45. The National Institutes of Health Workshop on Fetal Treatment: needs assessment and future directions.
- Author
-
Chescheir NC and Socol M
- Subjects
- Animals, Clinical Trials as Topic, Female, Fetal Therapies ethics, Humans, Informed Consent, Models, Animal, Pregnancy, Public Health, United States, Fetal Therapies trends, Needs Assessment
- Abstract
The National Institute of Child Health and Human Development and Office of Rare Diseases convened a multidisciplinary group of experts on August 16-17, 2004, for a workshop entitled ''Fetal Treatment: Needs Assessment and Future Directions.'' The purpose of the workshop was to develop a plan for the surgical, obstetric, neonatal, and maternal-fetal fields for the evaluation and dissemination of maternal-fetal surgical innovations and to further the scientific evaluation of maternal-fetal surgery. This article highlights the discussions and outlines recommendations for the future. An overarching recommendation was for the formation of a cooperative group of investigators and clinicians to help set a national agenda for research and clinical progress, as well as emphasize ethical issues.
- Published
- 2005
- Full Text
- View/download PDF
46. Aortic valvuloplasty in the fetus: technically possible but is it ready for prime time?
- Author
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Latson LA
- Subjects
- Fetal Therapies ethics, Fetal Therapies methods, Humans, Treatment Outcome, Aortic Valve Stenosis therapy, Catheterization ethics, Catheterization methods, Fetal Diseases therapy
- Published
- 2005
- Full Text
- View/download PDF
47. Causing disabled people to exist and causing people to be disabled.
- Author
-
McMahan J
- Subjects
- Abortion, Eugenic ethics, Aphrodisiacs adverse effects, Embryo, Mammalian, Female, Fetal Therapies ethics, Fetus, Genetic Testing ethics, Humans, Parents, Personhood, Preconception Injuries, Pregnancy, Prejudice, Value of Life, Wrongful Life, Beginning of Human Life ethics, Disabled Persons, Ethical Analysis, Preimplantation Diagnosis ethics, Prenatal Diagnosis ethics, Prenatal Injuries diagnosis, Reproductive Behavior ethics
- Published
- 2005
- Full Text
- View/download PDF
48. An ethical framework for fetal research.
- Author
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Chervenak FA and McCullough LB
- Subjects
- Female, Fetus surgery, Humans, Informed Consent ethics, Informed Consent standards, Pregnancy, Risk Assessment, Surgical Procedures, Operative ethics, Clinical Trials as Topic ethics, Clinical Trials as Topic standards, Fetal Research ethics, Fetal Therapies ethics, Fetal Therapies methods, Pregnant Women
- Published
- 2003
49. Catholic teaching and the law concerning the new reproductive technologies.
- Author
-
Alvare HM
- Subjects
- Beginning of Human Life, Coitus, Commodification, Embryo Disposition ethics, Embryo Research ethics, Embryo, Mammalian, Eugenics, Fetal Therapies ethics, Humans, Marriage, Public Policy, Reproductive Techniques, Assisted legislation & jurisprudence, Catholicism, Reproductive Techniques, Assisted ethics, Value of Life
- Published
- 2002
50. Over the tiniest patients, big ethical questions: fetal surgery's growing reach raises issues of need and risks.
- Author
-
Okie S
- Subjects
- Female, Humans, Pregnancy, Pregnant Women, Risk Assessment, Surgical Procedures, Operative ethics, Therapies, Investigational, Treatment Outcome, Fetal Therapies ethics, Fetus surgery, Spinal Dysraphism surgery
- Published
- 2000
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