Fetal anomalies: ethical and legal considerations in screening, detection, and management

The obstetrician has a duty, based on the ethical principle of beneficence, to provide emotional support to the pregnant woman who learns that her fetus has an anomaly. There also is a duty, arising from the principle of autonomy, to help the pregnant woman make informed decisions about care that are based on her values and goals. The determination of viability, for the purpose of abortion decisions, is based on US Supreme Court statements on the definition of viability. After viability, the physician should recommend aggressive management or nonaggressive management, depending on an analysis of the risks and benefits to the pregnant woman and fetus in the particular case. The physician's decisions about management should respect the informed considered wishes of the mentally competent pregnant woman.