Weighing the Social and Ethical Considerations of Maternal-Fetal Surgery.

TitleWeighing the Social and Ethical Considerations of Maternal-Fetal Surgery.
Publication TypeJournal Article
Year of Publication2017
AuthorsAntiel RM, Flake AW, Collura CA, Johnson MP, Rintoul NE, Lantos JD, Curlin FA, Tilburt JC, Brown SD, Feudtner C
JournalPediatrics
Date Published2017 Nov 03
ISSN1098-4275
Abstract

OBJECTIVES: The ethics of maternal-fetal surgery involves weighing the importance of potential benefits, risks, and other consequences involving the pregnant woman, fetus, and other family members. We assessed clinicians' ratings of the importance of 9 considerations relevant to maternal-fetal surgery.

METHODS: This study was a discrete choice experiment contained within a 2015 national mail-based survey of 1200 neonatologists, pediatric surgeons, and maternal-fetal medicine physicians, with latent class analysis subsequently used to identify groups of physicians with similar ratings.

RESULTS: Of 1176 eligible participants, 660 (56%) completed the discrete choice experiment. The highest-ranked consideration was of neonatal benefits, which was followed by consideration of the risk of maternal complications. By using latent class analysis, we identified 4 attitudinal groups with similar patterns of prioritization: "fetocentric" (n = 232), risk-sensitive (n = 197), maternal autonomy (n = 167), and family impact and social support (n = 64). Neonatologists were more likely to be in the fetocentric group, whereas surgeons were more likely to be in the risk-sensitive group, and maternal-fetal medicine physicians made up the largest percentage of the family impact and social support group.

CONCLUSIONS: Physicians vary in how they weigh the importance of social and ethical considerations regarding maternal-fetal surgery. Understanding these differences may help prevent or mitigate disagreements or tensions that may arise in the management of these patients.

DOI10.1542/peds.2017-0608
Alternate JournalPediatrics
PubMed ID29101225