Legal and ethical issues in fetal surgery

Recent research in the USA has shown the advantages for children's welfare of open fetal surgery over postnatal treatment for myelomeningocele. However, a balance must be struck between complications of premature birth risked by prenatal surgery and the long-term advantages for affected children's health, including mobility and neurologic capacity. Risks for women are repeated surgery for intervention and delivery. The research raises legal and ethical questions about how fetal interests should influence women's choices, and whether women may decline interventions in their pregnancies that offer their children lifelong advantages. Beyond fetal interests and women's preferences are state interests in fetal life, which in the USA and elsewhere have been expressed in judicially authorized cesarean deliveries. Underlying issues are the nature of fetal interests; contrasting entitlements to care from their mothers of fetuses and born children; healthcare providers' responsibilities toward fetuses; and duties of care, information, and advice to pregnant women.