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Attitudes of paediatric and obstetric specialists towards prenatal surgery for lethal and non-lethal conditions
  1. Ryan M Antiel1,2,3,
  2. Farr A Curlin4,
  3. John D Lantos5,
  4. Christopher A Collura6,
  5. Alan W Flake1,
  6. Mark P Johnson1,
  7. Natalie E Rintoul1,
  8. Stephen D Brown7,
  9. Chris Feudtner1,3
  1. 1Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
  2. 2Department of General Surgery, Mayo Clinic, Rochester, Minnesota, USA
  3. 3Department of Medical Ethics and Health Policy, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA
  4. 4Trent Center for Bioethics, Humanities and History of Medicine, Duke University, Durham, North Carolina, USA
  5. 5Department of Pediatrics, Children’s Mercy Hospital, Kansas City, Missouri, USA
  6. 6Division of Neonatology, Mayo Clinic, Rochester, Minnesota, USA
  7. 7Department of Radiology, Boston Children’s Hospital, Boston, Massachusetts, USA
  1. Correspondence to Chris Feudtner, University of Pennsylvania, Perelman School of Medicine, Philadelphia PA; feudtner{at}email.chop.edu

Abstract

Background While prenatal surgery historically was performed exclusively for lethal conditions, today intrauterine surgery is also performed to decrease postnatal disabilities for non-lethal conditions. We sought to describe physicians’ attitudes about prenatal surgery for lethal and non-lethal conditions and to elucidate characteristics associated with these attitudes.

Methods Survey of 1200 paediatric surgeons, neonatologists and maternal–fetal medicine specialists (MFMs).

Results Of 1176 eligible physicians, 670 (57%) responded (range by specialty, 54%–60%). In the setting of a lethal condition for which prenatal surgery would likely result in the child surviving with a severe disability, most respondents either disagreed (59%) or strongly disagreed (19%) that they would recommend the surgery. Male physicians were twice as likely to recommend surgery for the lethal condition, as were physicians who believe that abortion is morally wrong (OR 1.75; 95% CI 1.0 to 3.05). Older physicians were less likely to recommend surgery (OR 0.57; 95% CI 0.36 to 0.88). For non-lethal conditions, most respondents agreed (66% somewhat, 4% strongly) that they would recommend prenatal surgery, even if the surgery increases the risk of prematurity or fetal death. Compared with MFMs, surgeons were less likely to recommend such surgery, as were physicians not affiliated with a fetal centre, and physicians who were religious (ORs range from 0.45 to 0.64).

Conclusion Physician’s attitudes about prenatal surgery relate to physicians’ beliefs about disability as well as demographic, cultural and religious characteristics. Given the variety of views, parents are likely to receive different recommendations from their doctors about the preferable treatment choice.

  • disability
  • embryos and fetuses
  • surgery

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Footnotes

  • Contributors RMA carried out the initial analysis and drafted the initial manuscript. RMA, FAC and CF obtained funding for this study. All the authors contributed equally to the conceptualisation and designing the survey instrument, critically reviewed the article and suggested revisions and approved the final manuscript as submitted.

  • Funding Greenwall Foundation.

  • Competing interests None declared.

  • Ethics approval Mayo Clinic Institutional Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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