- Frank J. Leavitt, Ph.D.,
The Faculty of Health Sciences, Ben Gurion University of the Negev, 84105 Beer Sheva, Israel
Among people with religious and other ethical objections to abortion, there may be an automatic opposition to any prenatal testing of fetuses. For it is often believed that the only way to correct fetal defects is abortion. Similarly, people who have no ethical problems with abortion may see it as a matter-of-course response to diagnosed fetal defects. But there are other uses to which one might put a diagnosis of fetal abnormalities. More emphasis is being put these days, for example, on using the diagnosis to prepare for social and other support of affected families (Clarke, A. (1993) "Response to: What counts as success in genetic counseling?", J. Med. Ethics 19:47-49.
Important progress is also being made with various forms of medical and surgical interventions aimed at correcting problems in utero. A recent review article (Langham, M. R. Jr, & Rieger, K. M. (1994) "Advances in fetal surgery", Surgery Annual 26: 193-226) is therefore very welcome. The authors outline various approaches to fetal testing (embryoscopy, ultrasound, umbilical vein sampling, biopsy, genetic testing, amniocentesis) as well as various medical and surgical techniques being tried in utero for hydrocephalus, renal anomalies, congenital diaphragmatic hernia, etc. There is also some speculation on molecular therapy. The authors are aware of the ethical importance of the fact that many fetal surgical procedures are still highly experimental and of uncertain value. The results of in utero shunting for relieving hydrocephalus, for example, have turned out to be "no better than historical experience with untreated patients" (p. 210). Intelligent counseling and genuinely informed consent are therefore very important before fetal surgery be considered. The review article has a bibliography with 170 items on both clinical and ethical aspects, which will be very useful to those interested in the subject. Although the field is at present still highly experimental, hopefully in the future couples informed of fetal abnormalities will not have to choose between abortion and a deformed child. In many cases the third alternative may be in utero intervention and a healthy baby.