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Informed consent, bioethical equipoise, and hypoplastic left heart syndrome
Constantine Mavroudis1, Constantine D Mavroudis, Ruth M Farrell
1Department of Pediatric and Adult Congenital Heart Surgery, Center for Ethics, Humanities and Spiritual Care, Cleveland Clinic Children's Hospital, 9500Euclid Avenue/M41-02, Cleveland, Ohio 44195, USA. mavrouc@ccf.org
Cardiology in the Young
|December 14, 2011
Summary
Informed consent for hypoplastic left heart syndrome (HLHS) diagnosis is complex, varying significantly between regions. This review examines ethical considerations and physician duties in managing HLHS cases.
Area of Science:
- Medical Ethics
- Cardiology
- Neonatal Care
Background:
- Prenatal diagnosis of complex progressive cardiac conditions like hypoplastic left heart syndrome (HLHS) offers new management avenues.
- The potential for diverse outcomes challenges informed consent for the mother-fetus dyad.
- Observed variations in pregnancy termination rates for HLHS suggest inconsistent informed consent practices.
Purpose of the Study:
- To review ethical considerations and physician responsibilities regarding informed consent for HLHS.
- To analyze informed consent processes across different medical specialties involved in HLHS care.
- To explore the implications for termination of pregnancy, comfort care, and surgical palliation.
Main Methods:
- Literature review focusing on ethical frameworks and clinical practices.
- Analysis of informed consent challenges in prenatal and postnatal HLHS management.
- Examination of multidisciplinary physician roles (obstetrician, perinatologist, cardiologist, surgeon).
Main Results:
- Informed consent practices for HLHS are not standardized across clinical settings.
- Significant ethical equipoise exists regarding the scope and limitations of informed consent in HLHS.
- Discrepancies in termination rates highlight variability in clinical decision-making.
Conclusions:
- Current informed consent for HLHS is highly variable and lacks standardization.
- Ethical debates continue regarding the appropriate application of informed consent in HLHS.
- A need for standardized ethical guidelines in managing HLHS is evident.
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