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Ethical Considerations in Fetal Cardiology
Stefani Samples1, Rupali Gandhi2,3, Joyce Woo1
1Division of Pediatric Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA.
Insights
Fetal cardiology advancements improve congenital heart disease diagnosis and treatment planning prenatally. Ethical considerations in fetal cardiology encompass equitable care, informed consent, and decision-making for improved patient outcomes.
Area of Science:
- Biomedical Ethics
- Cardiology
- Maternal-Fetal Medicine
Background:
- Fetal cardiology has advanced significantly over 40 years.
- Diagnosis and management of congenital heart disease (CHD) have shifted from postnatal to prenatal periods.
- This evolution necessitates addressing complex ethical issues.
Purpose of the Study:
- To review the literature on ethical issues in fetal cardiology.
- To provide an ethical analysis of key aspects of fetal cardiac care.
- To explore the implications of advancements in prenatal diagnosis and intervention.
Main Methods:
- Literature review of fetal cardiology and biomedical ethics.
- Ethical analysis framework applied to diagnosis, care delivery, counseling, and intervention.
- Examination of decision-making processes and patient rights.
Main Results:
- Improved prenatal detection and diagnostic capabilities raise ethical questions.
- Ensuring equitable access to comprehensive care is crucial.
- Informed consent and shared decision-making are complex in fetal interventions.
- Ethical considerations surround the appropriate use of in utero interventions.
Conclusions:
- Accurate and timely diagnosis is ethically paramount.
- Equitable delivery of care must be prioritized.
- Shared decision-making and informed consent require careful navigation.
- Innovation in fetal cardiac interventions must be ethically grounded.
Abstract:
Fetal cardiology has evolved over the last 40 years and changed the timing of diagnosis and counseling of congenital heart disease, decision-making, planning for treatment at birth, and predicting future surgery from the postnatal to the prenatal period. Ethical issues in fetal cardiology transect multiple aspects of biomedical ethics including improvement in prenatal detection and diagnostic capabilities, access to equitable comprehensive care that preserves a pregnant person's right to make decisions, access to all reproductive options, informed consent, complexity in shared decision-making, and appropriate use of fetal cardiac interventions. This paper first reviews the literature and then provides an ethical analysis of accurate and timely diagnosis, equitable delivery of care, prenatal counseling and shared decision-making, and innovation through in utero intervention.
