First name
Stephen
Middle name
D
Last name
Brown

Title

Weighing the Social and Ethical Considerations of Maternal-Fetal Surgery.

Year of Publication

2017

Date Published

2017 Nov 03

ISSN Number

1098-4275

Abstract

<p><strong>OBJECTIVES: </strong>The ethics of maternal-fetal surgery involves weighing the importance of potential benefits, risks, and other consequences involving the pregnant woman, fetus, and other family members. We assessed clinicians' ratings of the importance of 9 considerations relevant to maternal-fetal surgery.</p>

<p><strong>METHODS: </strong>This study was a discrete choice experiment contained within a 2015 national mail-based survey of 1200 neonatologists, pediatric surgeons, and maternal-fetal medicine physicians, with latent class analysis subsequently used to identify groups of physicians with similar ratings.</p>

<p><strong>RESULTS: </strong>Of 1176 eligible participants, 660 (56%) completed the discrete choice experiment. The highest-ranked consideration was of neonatal benefits, which was followed by consideration of the risk of maternal complications. By using latent class analysis, we identified 4 attitudinal groups with similar patterns of prioritization: "fetocentric" (n = 232), risk-sensitive (n = 197), maternal autonomy (n = 167), and family impact and social support (n = 64). Neonatologists were more likely to be in the fetocentric group, whereas surgeons were more likely to be in the risk-sensitive group, and maternal-fetal medicine physicians made up the largest percentage of the family impact and social support group.</p>

<p><strong>CONCLUSIONS: </strong>Physicians vary in how they weigh the importance of social and ethical considerations regarding maternal-fetal surgery. Understanding these differences may help prevent or mitigate disagreements or tensions that may arise in the management of these patients.</p>

DOI

10.1542/peds.2017-0608

Alternate Title

Pediatrics

PMID

29101225

Title

Attitudes of paediatric and obstetric specialists towards prenatal surgery for lethal and non-lethal conditions.

Year of Publication

2018

Number of Pages

234-8

Date Published

2018 Apr

ISSN Number

1473-4257

Abstract

<p><strong>BACKGROUND: </strong>While prenatal surgery historically was performed exclusively for lethal conditions, today intrauterine surgery is also performed to decrease postnatal disabilities for non-lethal conditions. We sought to describe physicians' attitudes about prenatal surgery for lethal and non-lethal conditions and to elucidate characteristics associated with these attitudes.</p>

<p><strong>METHODS: </strong>Survey of 1200 paediatric surgeons, neonatologists and maternal-fetal medicine specialists (MFMs).</p>

<p><strong>RESULTS: </strong>Of 1176 eligible physicians, 670 (57%) responded (range by specialty, 54%-60%). In the setting of a lethal condition for which prenatal surgery would likely result in the child surviving with a severe disability, most respondents either disagreed (59%) or strongly disagreed (19%) that they would recommend the surgery. Male physicians were twice as likely to recommend surgery for the lethal condition, as were physicians who believe that abortion is morally wrong (OR 1.75; 95% CI 1.0 to 3.05). Older physicians were less likely to recommend surgery (OR 0.57; 95% CI 0.36 to 0.88). For non-lethal conditions, most respondents agreed (66% somewhat, 4% strongly) that they would recommend prenatal surgery, even if the surgery increases the risk of prematurity or fetal death. Compared with MFMs, surgeons were less likely to recommend such surgery, as were physicians not affiliated with a fetal centre, and physicians who were religious (ORs range from 0.45 to 0.64).</p>

<p><strong>CONCLUSION: </strong>Physician's attitudes about prenatal surgery relate to physicians' beliefs about disability as well as demographic, cultural and religious characteristics. Given the variety of views, parents are likely to receive different recommendations from their doctors about the preferable treatment choice.</p>

DOI

10.1136/medethics-2017-104377

Alternate Title

J Med Ethics

PMID

29018178

Title

Prenatal Decision-Making for Myelomeningocele: Can We Minimize Bias and Variability?

Year of Publication

2015

Number of Pages

409-11

Date Published

2015 Sep

ISSN Number

1098-4275

DOI

10.1542/peds.2015-1181

Alternate Title

Pediatrics

PMID

26240211

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