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Chapter 4 - Maternal–Fetal Surgery and the “Profoundest Question in Ethics”

from Part I - Starting at the Beginning

Published online by Cambridge University Press:  17 May 2025

By
Mark J. Bliton
Edited by
Paul J. Ford  and
Denise M. Dudzinski
Paul J. Ford
Affiliation:
The Cleveland Clinic Foundation, Cleveland
Denise M. Dudzinski
Affiliation:
University of Washington School of Medicine, Seattle
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Summary

In this chapter of Complex Ethics Consultations: Cases that Haunt Us, the author explores the complexities of maternal–fetal surgery when it was in its infancy. When spina bifida was detected at 18 weeks gestational age, the patient and her partner chose not to terminate the pregnancy. The ethics consultant explored emotional, ethical, medical, and social issues that impact her decision, including the risk of losing the pregnancy because of the surgical intervention. She lost the baby and the ethics consultant is struck by the patient’s tenderness in the midst of great loss. He digs deeply into the fragility of being human and the preciousness of sharing these experiences with patients and their families.

Keywords

hauntingmaternal fetal surgeryspina bifidaethics consultationhigh-risk pregnancy

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Type
Chapter
Information
Complex Ethics Consultations
Cases that Haunt Us
 , pp. 33 - 38
Publisher: Cambridge University Press
Print publication year: 2025

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References

Bliton, MJ. Ethics: “Life before birth” and moral complexity in maternal–fetal surgery for spina bifida. Clin Perinatol, 2003; 30: 449–64.CrossRefGoogle Scholar
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Lyerly, AD, Mahowald, MB. Maternal–fetal surgery for treatment of myelomeningocele. Clin Perinatol, 2003; 30: 155–65.CrossRefGoogle ScholarPubMed
Bruner, JP, Tulipan, N. Intrauterine repair of spina bifida. Clin Obstet Gynecol, 2005; 48(4): 942–55.CrossRefGoogle ScholarPubMed
Management of Myelomeningocele Study (MOMS): A Randomized Trial of Prenatal Versus Postnatal Repair of Myelomeningocele. Rockville, MD: National Institute of Child Health and Human Development, Fetal Surgery Units Group, 2003.Google Scholar
Bliton, MJ, Zaner, RM. Over the cutting edge: How ethics consultation illuminates the moral complexity of open-uterine fetal repair of spina bifida and patients’ decision making. J Clin Ethics, 2001; 12(4): 346–60.CrossRefGoogle ScholarPubMed
Churchill, LR, Bliton, M, eds. Parental voices in maternal–fetal surgery. Clin Obstet Gynecol, 2005; 48(3): 509–607.CrossRefGoogle Scholar
Doherty, D, Shurtleff, DB. Pediatric perspective on prenatal counseling for myelomeningocele. Birth Defects Res A Clin Mol Teratol, 2006; 76: 645–53.CrossRefGoogle ScholarPubMed
Nietzsche, F. Philosophy in the Tragic Age of the Greeks. Translated by Cowan, M.. Washington, DC: Regnery Publishing, 1962 (reprinted 1996); 48.Google Scholar
Zaner, RM. The Context of Self: A Phenomenological Inquiry Using Medicine as a Clue. Athens, OH: Ohio University Press, 1981; 52–5.Google Scholar
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Bliton, MJ, Finder, SG. Traversing boundaries: Clinical ethics and moral experience in the withdrawal of life supports. Theor Med Bioeth, 2002; 23(3): 233–58.CrossRefGoogle ScholarPubMed
Harris, LH. Rethinking maternal–fetal conflict: Gender and equality in perinatal ethics. Obstet Gynecol, 2000; 96(5): 786–91.Google ScholarPubMed

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