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Fatal fetal paternalism
  1. Dominic Wilkinson1,2
  1. 1The Robinson Institute, Discipline of Obstetrics and Gynecology, University of Adelaide, Adelaide, South Australia, Australia
  2. 2Program on Ethics and the New Biosciences, Oxford Uehiro Centre for Practical Ethics, The University of Oxford, Oxford, UK
  1. Correspondence to Dr Dominic Wilkinson, Discipline of Obstetrics and Gynecology, Women's and Children's Hospital, University of Adelaide, 72 King William Rd, North Adelaide, SA 5006, Australia; dominic.wilkinson{at}


Heuser and colleagues' survey of obstetricians provides a valuable insight into the current management of severe fetal anomalies in the United States. Their survey reveals two striking features - that counselling for these anomalies is far from neutral, and that there is significant variability between clinicians in their approach to management. In this commentary I outline the reasons to be concerned about both of these. Directiveness in counselling arguably represents a form of paternalism, and the evident variability in practice is likely the result of physician personal values. However, Heuser's survey may, by shining a light on practice, provide an important step towards a more consistent approach.

  • Newborns and minors
  • withdrawal/withholding treatment
  • best interests
  • neonatology
  • intensive care
  • clinical ethics
  • allowing minors to die
  • donation/procurement of organs/tissues
  • prolongation of life and euthanasia
  • quality/value of life/personhood

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  • Linked article 100340.

  • Funding This work was supported by an early career fellowship from the Australian National Health and Medical Research Council [1016641].

  • Competing interests None.

  • Provenance and peer review Commissioned; internally peer reviewed.

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