An ethically justified, clinically comprehensive management strategy for third-trimester pregnancies complicated by fetal anomalies

Abstract

We present an ethically justified, clinically comprehensive management strategy for third-trimester pregnancies complicated by fetal anomalies, based on 72 cases diagnosed at a gestational age of more than 24 weeks. These cases are organized into three categories: A) nonaggressive management and termination of pregnancy offered, three of 72 (4%); B) aggressive and nonaggressive management offered, 18 of 72 (25%); and C) aggressive management recommended, 51 of 72 (71%). We then ethically justify a clinically comprehensive management strategy. First, we describe the disclosure requirements of the informed-consent process. Second, we provide an ethical justification for the physician’s recommendations among management alternatives. The justification for such recommendations is based on a continuum of beneficence-based obligations to the fetus that is developed in terms of a classification scheme of fetal anomalies, based on the degree of probability of antenatal diagnosis and degree of probability of outcome. When there are ho beneficence-based obligations to the fetus, the physician should recommend only termination of pregnancy or nonaggressive management. When there are minimal beneficence-based obligations to the fetus, only aggressive or nonaggressive management should be recommended. Finally, when there are more than minimal beneficence-based obligations to the fetus, only aggressive management should be recommended. © 1990 The American College of Obstetricians and Gynecologists.