Prenatal intervention: ethical considerations for life-threatening and non-life-threatening anomalies

Ethical issues in maternal-fetal surgery require special consideration because of the often-conflicting interests of the mother and fetus. Over the past 2 decades an ethical framework for fetal therapy and maternal-fetal surgery has been developed. This framework continues to evolve as new procedures are developed and new controversies arise. The most recent ethical challenge has been the application of maternal-fetal surgery to nonlethal fetal anomalies, specifically, repair of fetal myelomeningocele. Such procedures require early evaluation by randomized clinical trials to avoid premature dissemination of unproven therapy. These trials currently are being initiated, and the ethical framework for proceeding requires careful consideration. This review will summarize the current ethical issues and controversies in maternal-fetal surgery in the context of these new developments.