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[Aporia of prenatal medicine]
1Frauenklinik im Klinikum Grosshadern der Ludwig-Maximilian-Universität, München, Deutschland. hermann.hepp@helios.med.uni-muenchen.de
Insights
Prenatal medicine advances raise ethical questions about the
Area of Science:
- * Medical Ethics
- * Obstetrics
- * Reproductive Medicine
Context:
- * Prenatal medicine plays a crucial role in modern obstetrics, addressing quality of life for both mother and fetus.
- * Societal expectations have evolved, leading to an increased demand for 'healthy children'.
- * Ethical dilemmas arise when diagnostic capabilities exceed therapeutic options, particularly concerning selective termination.
Purpose:
- * To explore the ethical implications of prenatal diagnostic measures.
- * To examine the legal and ethical considerations surrounding the concept of 'the child as damage'.
- * To discuss the complexities introduced by advancements like preimplantation diagnostics.
Summary:
- * Prenatal diagnostic examinations are central to prenatal medicine, raising profound questions about human worth and the definition of a 'healthy child'.
- * Ethical scrutiny is applied to intrauterine diagnostics when they are not coupled with intrauterine therapy, potentially leading to termination.
- * Legal and ethical challenges emerge concerning parental obligations, iatrogenic preterm birth, and the protection afforded to liveborn infants with disabilities.
Impact:
- * Highlights the dual nature of prenatal medicine, balancing diagnostic advancements with ethical responsibilities.
- * Informs ongoing societal and political discussions regarding reproductive technologies and fetal rights.
- * Underscores the need for careful consideration of liability and the definition of 'damage' in the context of prenatal care.
Abstract:
Prenatal medicine touches upon elementary questions of the quality of life - of the mother as well as of the unborn child and of the physician. In essence, it is always about the determination of human worth by human beings. Each prenatal care examination is a measure of prenatal medicine. Prenatal medicine has gained today, and rightly so, a high and positive position in obstetrics and within our society. Without a doubt however, the advancements of prenatal medicine have also awakened demands and desires. We are increasingly faced with the 'demand for a healthy child'. In the ethical evaluation, intrauterine diagnostic measures are questionable as long as no intrauterine therapy is possible and only the killing of the child follows as 'therapy'. The contents of the 'indication', especially with respect to what can reasonably be demanded from the mother or the parents, are discussed with respect to liability law - 'the child as damage'. The reform of 218 StGB (German criminal law code) has provoked, among other issues, the pre- and postnatal problem of iatrogenic preterm birth. The ever present question is becoming more transparent with the liveborn sick child, which should have actually died, i.e. why instead the life of this child suddenly assumes the full legal protection so that active handling is replaced by passiveness. The two-facedness of prenatal medicine appears even more clearly when picturing the current political discussions concerning what is newly feasible in prenatal medicine, namely preimplantation diagnostics.