Ethical considerations in prenatal surgical consultation

When pediatric surgeons counsel the prospective parents of a fetus with a major congenital anomaly, medical and ethical issues may arise in one or more contexts. There may be: (1) issues concerning the possibility of in-utero intervention or termination of pregnancy; (2) issues surrounding the timing, location and mode of delivery; and (3) issues concerning possible operative interventions after the birth. The virtues of compassion, honesty, and integrity should guide the surgeon in helping the parents confront the diagnosis of a fetal malformation. The ethical principles that inform the prenatal consultation should include respect for autonomy, reproductive freedom, beneficence, and justice. Ethical conflict may develop if the pregnant woman chooses a course of action that is inconsistent with traditional pediatric surgical recommendations.