Original Work Assessment
Overview of Original Work
Dates: October 5, 2020- December 14, 2020
Objective:
After many changes to my plans, my objective settled on evaluating the ethical considerations for the evolving field of fetal surgery. That in itself was a broad topic. When focusing my ideas, I decided to evaluate factors that could compromise a woman’s autonomy during decision making for fetal treatment and then further propose solutions to combat such influences.
Description of Process:
The direction for my original work changed as I learned more and developed my ideas. Initially, the objective was to research spina bifida- and more specifically myelomeningocele. I was going to gather information and create a report about what the condition is and the current treatment options- as well as the still-developing ones. It was going to contribute to my final product that would inform parents and aid in their decision making when they are faced with the decision of treatment after their unborn child is diagnosed with myelomeningocele. However, this- ultimately- changed. After further research and in-depth conversations with my mentor, Dr. Terry Buchmiller, I found myself interested in more fundamentally challenging questions. I was still planning on diving into the challenges of the difficult decision making but I realized I was limiting what I thought I could learn, understand, and produce. I began to shift the focus of my research from physiological, clinical research papers to those evaluating the evolution of fetal surgery and its ethical implications.
From this, I focused on the recent shift in fetal surgery from treating only life-threatening conditions to quality-of-life conditions as myelomeningocele was recently accepted as viable for fetal treatment. Such a shift seemed to disrupt all the ethical foundations I had read about in my research. When I understood how and why the shift was acceptable, I realized the impact of that understanding. This was what changed my overall original work idea. Understanding such a change heavily impacted my view of the change in condition specification. I began to develop the idea that the same understanding may aid or contribute to a deciding parents’ views as well. I began researching the influences on the decision-making process for the mother- because the mother’s autonomy is currently held with the highest precedence. Ultimately, I decided to explore the ethical implications of the evolution of fetal surgery and the influences that could obscure such medical decisions. Because the shift in the field is what I found essential, I made sure to include it in my project, using congenital diaphragmatic hernia and myelomeningocele as examples to further my point- that way my previous research could still be used.
Eventually, I came up with an outline and plan for my original work; it evolved from a report to a medical ethics paper. With the help and guidance of Dr. Buchmiller, I was able to mature my ideas. She directed me to many resources and gave me feedback and reassurance on my ideas and direction throughout. I would not have been able to gain such impactful knowledge without her help and time.
Utilization of Higher-Level Thinking Skills:
There were many higher-level thinking skills I utilized during the process of creating my original work project. While, initially, my original work was going to be focused more on evaluation, it ended up being a combination of synthesis, evaluation, and analysis. Creating a medical ethics paper was not a superficial task. In fact, it took much existential, philosophical, and moral thought, while exploring and learning of medical developments and evolution. I have become accustomed to not only complex medical research papers but also ethical reports. Higher-level thinking skills were utilized to understand the field and ethical reasoning and propose a solution to the discrepancies found.
Results:
The overall results of my project and paper left me surprised by my abilities to understand such intricate concepts and develop such complex ideas. With that being said,-there is no doubt- I have room for improvement. I plan to use this to understand my strengths and weaknesses to grow personally. In general, I am proud of the result of my hard work.
Conclusions/Interpretations:
The journey of developing my project gave me a deeper understanding of the inner workings of clinical studies and the many ethical considerations I was previously unaware of. Ethics was not something I had originally thought I would focus on- I did not know the weight of such ideas. Reading and understanding medical ethics have, overall, significantly influenced my grasp of medicine. There were many factors I had not considered. Writing this paper and using higher-level thinking skills to immerse myself in the ideas and debates has added to my perspective and deeply made an impression on me.
In all, I believe medical ethics are vital for the continuing progression and development in the many medical fields. Though I have only a few months of exposure to a very focused part of medical ethics, I plan to grow and add to such knowledge. Reading and writing about ethics has aided me in understanding the importance of such comprehension- not only for medical professionals but- for individuals making medical decisions.
Original Work Proposal
Unum Shamim
Ms. Deborah Penney
Independent Study and Mentorship
05 October 2020
Original Work Proposal (Revisions Below)
There have been many new developments in pediatric surgery in the last few decades. Namely, the exploration of fetal surgery- or surgery done while the baby is still in the womb. Fetal surgery allows intervention during development. Before its introduction, surgeons would only treat congenital conditions after birth. While some children’s treatment options may be limited, others’ parents must make the ultimate decisions. Fetal surgery has many potential positive results, but is still on a trial basis for many conditions. Because fetal surgery may be considered relatively new, analyzing the development, techniques, and differences the surgery has from neonatal treatment options would be beneficial in understanding the continuing evolution of pediatric surgery. I will do so by focusing on one condition: spina bifida.
I propose the analysis and comparison of three procedures (neonatal, open-fetal, and fetoscopic meningocele repair) to create a comparison and analysis of their development and success. Gathering extensive research on spina bifida overall and the many types of the condition would be my first course of action. Then, I will investigate the neonatal surgical approach used for spina bifida. In doing so, I intend to learn of the specific surgical steps done and why these steps are done the way they are. By bringing together the information, I plan to create comprehensive diagrams and drawings of each step of the surgical treatment processes as well as the outcome and initial healing process. Repetition of these steps with the developing fetal surgical approaches for the condition will be necessary. During all aspects of research, professionals are going to be vital resources. Because they are relatively recent advancements, the fetal approaches are currently only done by select teams such as the team at the Children’s Hospital of Philadelphia. To gain insight, I am prepared to reach out to them and hospitals with similar expertise. The diagrams and illustrations will demonstrate a visual comparison that will be accompanied and explained by a report outlining the contrasting aspects of the treatments and their outcomes. While comparing fetal surgery to neonatal surgery, I will also compare the difference in fetal surgical approaches between the open-fetal surgery and fetoscopic surgery.
Overall, breaking down the new developments and intricate surgeries aids in my understanding of pediatric surgery as a whole. Researching, comparing, and understanding these aspects within the field will additionally contribute to my potential final product this year. As of now, I plan to either create a book outlining the different approaches, or to construct live models that demonstrate each surgical procedure for a better understanding by parents faced with these choices. Creating this report will be the first step towards eventually making a product that would aid in the understanding and processing of the important decisions regarding a child’s care.
Unum Shamim
Ms. Deborah Penney
Independent Study and Mentorship
20 November 2020
Revisions to Original Work Proposal
After extensive research and contemplation, I have decided to shift the focus of my original work. While I plan to remain focused on fetal surgery, I felt I was limiting myself with my initial original work idea. Because of this, I plan to- instead- write a report evaluating the ethics and the risks for fetal intervention for “life-threatening” conditions versus “quality-of-life” conditions. Originally, there was a strict sentiment that the risks for the mother would not outweigh the benefits of the fetus for treatment to improve the quality of life of the developing fetus. The shift in the treatment type came with the MOMS study for myelomeningocele (a quality-of-life condition). This trial- like all clinical research trials- had strict qualifications: mother’s health and condition, movement towards trial hospital locations, etc. These major restrictions to the trial cohort can skew results- meaning they may be different for different groups- and therefore cannot be regarded as a generalization for all myelomeningocele cases. To legitimize the results for all and create the accessibility for all, more research and studies need to be done. This idea is something I will need to consider throughout my report. There is a major question that grabbed my attention: If a clinical trial’s results override a major ethical point- despite the need for more research- where is the line drawn? I plan to use this project to propose my own take on ethics while presenting some suggestions of how this may be done..
In my report, I will explore the implications for both the quality-of-life and life-threatening conditions treated with fetal intervention and dive into the insinuation of the shift in types of conditions despite ethical considerations- using myelomeningocele and congenital diaphragmatic hernia as examples to further my points. I plan on exploring the psychological implications for the mother, the societal pressures, the fetal risk and benefit, the familial effects, and other factors I may find through more research. One major challenge I know I will face is presenting such complex ideas while exploring and explaining complex conditions before even fully diving into the ethics of it all. While it will be difficult, I truly believe that I can do so with much time and hard work- and that it will significantly add to my ethical points and arguments. Ethics are a major consideration for all types of medicine, and by developing my ideas around them and exploring them right now, I am furthering my knowledge for the future. In all, this will contribute to my understanding of the inner-workings of medicine and- specifically- fetal surgery.
Original Work Outline
*Major question is how fetal surgery can evolve to include quality of life conditions with respect to ethics*
What is Fetal surgery?
Reasons for fetal surgery talk about the restrictions and qualifications needed to be met to be eligible for treatment- originally only for life-threatening conditions because of risks (and their ethical implications)-
Talk about what the risks are
Introduce CDH as a life-threatening condition that is an example for ^
Include the complications and the seriousness of condition
Introduce quality of life conditions
MOMS, Myelomeniengocele
Include disclaimer: many still in trial so strict cohort criteria and research trial implications (moving to location, medical instruction, familial impact, etc.) limits the application of results to all or most cases for a conditions
Bring up the risks and dilemmas of fetal surgery again (previously mentioned above) and how MOMS challenged some major ethical questions regarding risk and outcome and how as CDH treatment developed the ethical boundaries were maintained because of the possibly fatal result of the condition and its major medical implications- what are the ethical considerations and why may this transition be grey- rather than black or white?
Ethics Using Key points
Lack of Physical Benefit for Mother- But psychological benefit
Familial benefit
Peace of mind for mother that she is doing something to try and help her unborn child
Social pressures and expectations for mothers decision if fetal surgery is a possibility (how to maintain mothers autonomy while also protecting her)
Is a mother's decision reliable with such pressures and implications?
Suggest required support system/group discussion before commitment to treatment- ensure that it is what's best for mother and baby- maybe psych consult
Balance of risks for mother and benefits for fetus
How do limited trial results without long term results completely override the foundational ethical point and consideration?
As more trials and studies happen for more conditions like MMC, where is the line implemented to protect the mother- when risks are too great for few fetal benefits?
As fetal surgery continues to expand to more “quality-of-life” conditions, what is to draw the line for mothers
Consider whether because of societal pressures or personal inclination- mother is likely to put the fetus first above her own health- if she is advocating for the fetus, who is advocating for herself?- but need to respect autonomy
Does mother have the right to decide for a fetus?
Consider fetal viability at that point
Take into account that for quality of life conditions- even without the prenatal intervention- the fetus typically has high probability of survival (with respect to other accompanied medical conditions)- so in certain situations, would putting mother and fetus’ life at risk for fetal intervention be okay?- in other words- would it be okay to put a fetus through surgery- it didn’t sign up for it
Consider, after birth, parents/guardians have the say-so for a child's treatment- so wouldn't the same principle apply to mother and fetus?
My take and position on ethical points- suggestions
Been debated on if treatment should only be considered and treated this way for life threatening conditions- agree to the ethical justification but believe mother’s autonomy should be considered above all else.
Completely inform mother of the harsh realities of the outcomes (as is typically required for medical procedures)- but go a step further to ensure mother completely understands what she is signing up for
While mothers autonomy needs to be respected, evaluation and much discussion- maybe even psych consult- to ensure that is what she truly wants- not just what she thinks she is supposed to want
Respect decision while ensuring it is truly her decision
Conclude by diving into continuing evolution, development, and accessibility that may blur the line further for mothers- how the restrictions/steps proposed might help out
Evolution and development may result in less risky forms of fetal treatment and create a whole new ethical discussion
Touch on increasing accessibility to such treatment as it evolves and screening criteria changes- mention of limited cohorts at beginning- touch on that again
The Ethical Considerations for the Evolution of Fetal Surgery: Combatting Influences while Respecting Women's Autonomy
Unum H. Shamim
Introduction
In the past century, medicine has overall evolved to explore the causes of disease and prevent them from happening rather than strictly treating the aftermath. The same idea has been implicated in the progression of development in fetal surgery. But like all medicine, fetal surgery comes with ethical considerations and implications that must be assessed and contemplated. As conditions- such as myelomeningocele- are being accepted for fetal treatment through clinical studies, previously established ethical foundations for the field have been disrupted. In turn, major questions arise regarding the risks, benefits, and autonomy of both the mother and fetus.
What is Fetal Surgery?
Fetal or prenatal surgery is a medical intervention on a fetus while they are still in the mother’s womb- before the baby’s birth. There are many different types of fetal surgery including open-fetal and fetoscopic surgery. Key technologies used for fetal diagnosis and surgery are ultrasounds and similar advancements that have made the growth and development of the field possible (1)(2). Intervention while the fetus is still in-utero enables physicians to address congenital conditions before or during their development to prevent damage or abnormal progression. Overall, they are expected to increase positive outcomes for otherwise devastating conditions- however, most treatments are still in stages of clinical testing. With the development of fetal surgery came criteria to be met for treatment: understanding and documentation of the disease and its prognosis, lack of postnatal treatment options, success through animal models, and ethical and clinical approval with informed parental consent (3)(4). There are many risks for both the fetus and the mother who undergo such procedures- including threats to the viability of the pregnancy, infection, hemorrhage, ureterectomy, internal damage, and possibly even death (1). Taking the risks into consideration, it is still not guaranteed the treatment will result in a positive outcome.
Because of this, -along with requirements that must be met- foundations of ethics were developed. One take on the ethical side of the field was proposed by Dr. Michael Harrison, the “Father of Fetal Surgery,” and was a generalized idea that has since been challenged: Fetal surgery should not be chosen as treatment unless there are reliable conclusions regarding the rate of fetal death and/or postnatal treatment is not an option (3). The premise behind such a sentiment evaluated the equipoise of maternal risk and fetal benefit. With this perspective, it could be understood that it was likely that only life threatening conditions would be viable for fetal treatment. However, there has been a recent evolution in the field that has grown to include myelomeningocele- a “quality-of-life” condition- as suitable for fetal treatment.
Life-Threatening Vs. Quality of Life
The main concern with fetal surgery continues to revolve around maintaining the balance between risks and benefits for both the mother and the fetus. Because of this, conditions often viewed as “life-threatening” or fatal showed more promise from an ethical standpoint (4). The benefit of possibly saving a fetus' life is enough to create an equal balance against the risks involved. A detrimental condition called congenital diaphragmatic hernia falls under this category and experimental fetal intervention has evolved to combat the fundamental development of the condition. With that being said, it seemed almost unlikely that a “quality-of-life” condition would have benefits that exceed the risks. However, with new studies and trials, data has shown a shift in fetal surgery to include one of the many congenital conditions that fall in this category- myelomeningocele.
Congenital Diaphragmatic Hernia
Congenital diaphragmatic Hernia or CDH is a congenital condition in which abnormalities of the diaphragm lead to the shift of abdominal organs into the thoracic cavity where the lungs are to develop. This causes defects in lung development and can lead to many respiratory problems. The main issue that occurs is that as the abdominal contents fill space in the chest, there is limited room for the lungs to develop and grow. Because of this, lungs are affected during development and can result in pulmonary hypertension and many more detrimental consequences- including strain on the heart and ventricular abnormalities(4)(5). Like many other conditions, it is not unlikely that CDH is the only condition that may be affecting a patient- however, the outcomes are expected to be better when CDH is the lone contributing factor (5). Because intervention during development could significantly alter the progression of the condition, it could ultimately prevent fatal outcomes. Because of the severe benefits- the fetus’ life- fetal surgery is ethically untroubled by such inclusion.
Myelomeningocele
Myelomeningocele or MMC is the most severe form of spina bifida. It is when the nerves of the spinal cord protrude to the posterior side of the skeletal spine. During development in the womb, this causes the nerves to be exposed to the amniotic fluid which is a harmful environment that results in damage to the nerves. MMC is not considered a fatal condition as it has a death rate of about 10% after live births (6). While the mortality rate is significantly low, the nerve and spinal cord damage are irreparable causing long-term disabilities for those affected.
Because of these life-long implications, fetal surgery was considered for treatment. The basis was to see if covering and closing the exposure of the spinal nerves to the uterine environment would prevent some of the damage and overall improve quality of life. But as before, the question of ethics must be discussed.
Previously, the mother was put under the risks of surgery and health implications that came with fetal surgery- however, it was to save the fetus’ life. In this instance, though, the fetus’ life is no longer at such a high risk if fetal treatment is not performed. There is a high chance the child will survive- however, the quality of life and state of disability may vary.
By implementing fetal surgery for myelomeningocele, the Management of Myelomeningocele or MOMS trials were done to assess if there was a significant difference in the outcome of treating myelomeningocele through open fetal surgery versus postnatal therapy (6). Initial results of the study concluded that there was a significant improvement of motor skills and a decrease in the need for a cerebrospinal fluid shunt- which is associated with hindbrain herniation that can result from MMC (6). With short-term conclusions being observed and recorded, there is a significant increase in chances of preterm delivery as well as uterine dehiscence. Both contribute to maternal risk (6).
Although the study proved fetal surgery as a plausible treatment option for myelomeningocele- with respect to expanding eligibility criteria-, it must be noted that such results may not be applicable to all myelomeningocele cases. Significantly, the research cohort was selected with strict inclusion and exclusion criteria (6). In relation, the procedures were performed by specific teams with predetermined operative techniques (6). This all together creates a strict cohort with specific outcomes that may not be deemed a generalization for all myelomeningocele- because of the specificity of the research cohort. With that being said, the results of MOMS still seemed to contradict the earlier sentiments about maternal and fetal risks and benefits, and trial results were essential to ensure the legitimacy of the practice (4).
Relatively recently, the MOMS2 results were published and explored. MOMS2 was a follow-up on the same groups that participated in the original MOMS trials. It dove into the long-term effects of the fetal treatment and how it affected “school-age functional outcomes” (7). From such results and conclusions, it can now be understood: There is no significant difference in adaptive behavior and cognitive functioning for those who were treated with fetal surgery- opposed to postnatally. However, there was a recorded increase and improvement in mobility and independence coupled with a decreased need for cerebrospinal fluid shunt placement or replacement (7). It must be noted that there are other developing methods of hindbrain herniation treatment that are not represented in the number of those in need of cerebrospinal fluid shunt.
With the understanding of the significant long-term effects of fetal treatment, the acceptance of myelomeningocele as a fetally treated condition comes with more ease. While the major concerns were the risks and benefits of the procedure, the long-term results of MOMS2 reviewed increased long-term effects. Ethically, though there are still considerable maternal risks, the equipoise remains due to the significance of increased long-term benefits. While previously, only short-term effects were available for contemplation, the results add to the overall optimistic impacts- not only on the child’s independence and overall quality of life but- on the level of the familial and parental strain (7). These overall benefits serve to maintain the ethical balance and in turn ease the approval and continuing inclusion of more “quality-of-life” conditions.
Ethical Dilemma
While the shift to include fetal surgery as an option for myelomeningocele treatment has been generally accepted because of all the reasons previously discussed, ethical discrepancies and disagreements are still to be debated. It would be accurate to describe this shift from life-threatening to quality-of-life conditions treated by fetal surgery as ethically grey. There are many different takes on the subject and factors that contribute to the ethical approach of the topic. While fetal treatment may be approved for certain conditions, a decision still needs to be made. Ethically, there are many factors that contribute to the decision-making of undergoing fetal surgery. Most notably are the understanding of the benefits and risks in context and the external pressures on the mother to decide what treatment is preferred. While after birth, the child’s care is determined both maternally and paternally- given two parents are in the picture-, treatment that would occur while the fetus is in utero is ultimately the mother’s decision. This is because of the involvement and implications such treatment would have on the mother. In such cases, it could be argued that the father has a say. While his view should be considered, the disproportionate involvement of the mother in whatever treatment is chosen outweighs any official paternal say in the matter.
After understanding the position of the mother to make drastic changes, the vital concepts to recognize the factors that contribute to such a decision- ethically.
Maternal Versus Fetal Benefits
Though it can be noted no physical benefit exists for the mother as a result of fetal surgery- in fact, it can be labeled as physically harmful-, it would be ignorant to dismiss the psychological benefits fetal treatments provide a mother. Mentally, it is human nature to feel the need to combat any predicted difficulties before they arise. This is heightened with the idea of maternal instinct. Advanced technology allows the diagnosis of congenital conditions before birth, and therefore leaves a desire for those involved in a case to feel the need to do something about it (2). The stress associated with such knowledge may be put at ease with the decision of early intervention through fetal surgery. To summarize, fetal treatment provides peace of mind for the mother as she is doing something to help her unborn child.
On that note, as previously discussed, the MOMS2 conclusions showed a significant overall decrease in familial strain for the maternal-fetal dyads treated fetally compared to those who were given postnatal treatment for myelomeningocele (7). While this may be linked to the level of disability resulting from the different treatments- such knowledge would contribute to the mother’s thought process as she goes through the difficult task of deciding what to do. The benefits and familial implications portrayed through the MOMS2 study add to the overall benefits for the mother. Traditionally, familial status and strain would overall impact the livelihood of mother and fetus. Therefore, it would be important such benefits be acknowledged and understood.
Despite the presence of such benefits, it is vital to keep in mind the many maternal and fetal risks- including the possibility of both maternal and fetal death (1).
External Psychological Pressures
While maternal autonomy is essential, there are many external factors and pressures that contribute to her decision. Though her choice must be respected, such factors could blur the line between what she truly wants and what she believes she is supposed to want.
Society
Societal pressures dictate how a pregnant woman should view her pregnancy and choices. Though often overlooked, the views and opinions of society and those around an individual create a stressful environment. Because of the expectation for a mother to put her unborn child’s life above her own, the reasoning behind the mother’s decision may not be in her best interest (2). The societal pressures could compromise the mother’s autonomy due to the strong dictation of opinions and criticisms.
Familial Obligations
Along with societal pressures, the implications and familial responsibilities of a mother greatly impact her decision. Though she would consider the risks and benefits of fetal surgery when making her decision, those are not the only factors that play a role in her ultimate verdict. While society is shifting away from the traditional domestic maternal role- no matter the familial structure- responsibilities are held by the mother. Whether it is domestic duties, a job, or other family commitments, the mother must take into consideration the implications of fetal surgery and the incapability of participating in such chores and duties during her pregnancy and the treatment (8). No matter the role of the individual, impacts on such responsibilities may be a considerable determining factor, and it is essential she understands all the insinuations of her choice.
Physicians’ Approach
Considerably, one of the most influential factors to the mother’s decision-making process is their physician’s attitude towards the treatment. Though the decision is ultimately the mother’s, the approach the professional has may heavily influence the mother’s own view of a treatment option. Medical counseling can be placed within two distinct categories: non-directive and paternalistic (9).
Non-directive counseling is when professionals attempt to provide an unbiased recollection of medical information. This way, the decision is ultimately the parents’ with no other influence. However, it is questionable if such a notion is at all possible. While it is sometimes unavoidable for a physician to provide their own views on a treatment, it may also be seen as failing to provide all necessary information because individuals may not have the ability to understand or make the decision themselves. Additionally, a disconnect occurs between professionals and patients when such decisions disrupt “a relationship of trust and openness” (9).
Medical paternalism is essentially the opposite of non-directive approaches. It is rooted in the idea that the physician takes control of decisions based on their experience and extensive medical background (9).
While such different approaches influence others’ views of their options, it is also important to understand that different professional specialties may influence the approach- more specific than simply nondirective and paternalistic counseling. When assessing the attitudes of congenital conditions by maternal-fetal medicine and fetal care pediatric specialists, it was found that their support for different options such as termination was highly differential (10). On that note, fetal care pediatric specialists are more likely to express the need for consultation before decisions are made (10). The varying views of the professionals that act as guidance for parents during such times, significantly contribute to their own views. Because of the relationship of trust created between a physician and the decision-makers, such perspectives are powerful. Discussion still remains revolving around the need for action if a decision is divergent from the recommendations of medical professionals (11). However, such a sentiment would override maternal autonomy that has already been discussed as paramount.
It must be noted that the presentation of risks and diseases contributes to the choices made by parents (9). Such factors must be acknowledged. Because of their influence, it may be reasonable to have a standardized approach to such presentations. Otherwise, decisions could be dictated by differences in the display rather than truly a reflection of the mother’s desires. It has also been reflected that external factors can limit the authenticity of a woman’s autonomy (8). Both major factors disrupt the ethical equipoise and acceptance of autonomy. The question remains of how to combat such variances while continuing to respect the mother’s autonomy.
Conclusions
Although there have been debates on whether the shift from life-threatening to quality-of-life conditions in fetal treatment is acceptable, the ethical justification is validated due to increased long-term beneficence- resulting in a remaining balance between risks and benefits. With that being said, though it is accepted, decisions must be made with respect to the mother’s autonomy above all else. While this is ideal, there are many factors that disrupt the authenticity of such a decision.
To combat the differences in the presentation of risks, benefits, and disease, I suggest the implementation of complete understanding for the parents and most importantly the mother. While informed consent is a requirement of medical procedures, there would be benefits in taking it a step further. This could be done by explaining and providing an explanation of the differences and the shift in fetal surgery. If a mother is deciding to agree to a fetal procedure that targets a quality of life condition, providing such an explanation creates a new perspective and reveals a larger picture that may ensure the mother’s complete understanding of what she is essentially signing up for.
On another note, while the mother’s autonomy needs to be respected- because of so many external influences and factors- extra steps may need to be taken to ensure the verdict she expresses is truly her decision. I propose this be done through a psychological evaluation to understand her motives and true intentions. While such a step can not override the mother’s perceived autonomy, it could reveal discrepancies that can then be further discussed to ensure sincerity in the decision.
As fetal surgery continues to evolve and become more accessible, these ethical considerations must not be overlooked. Nonetheless, new developments may result in less-risky forms of fetal treatment and present a whole new ethical discussion. Regardless, it is vital constant discussion and conference remain to combat and analyze the ethical and moral implications of all that is to come.
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