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Responsibly counselling women about the clinical management of pregnancies complicated by severe fetal anomalies
  1. Frank Chervenak1,
  2. Laurence B McCullough2
  1. 1Department of Obstetrics and Gynecology, Weill Medical College of Cornell University, New York, New York, USA
  2. 2Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas, USA
  1. Correspondence to Dr Laurence B McCullough, Center for Medical Ethics and Health Policy, Baylor College of Medicine, One Baylor Plaza MS 420, Houston, TX 77030-3411, USA; mccullou{at}


Heuser, Eller and Byrne provide important descriptive ethics data about how physicians counsel women on the clinical management of pregnancies complicated by severe fetal anomalies. The authors present an account of what such counselling ought to be based on, the ethical concept of the fetus as a patient and the professional responsibility model of obstetric ethics. When there is certainty about the diagnosis and either a very high probability of either death as the outcome of the anomaly or survival with severe and irreversible deficit of cognitive developmental capacity as a result of the anomaly diagnosed, the pregnant woman should be offered the alternatives of aggressive and non-aggressive obstetric management and induced abortion before viability. It is also ethically permissible to offer feticide followed by termination of pregnancy after viability in such cases. This ethically justified approach will reduce the variation in the actual practices of specialists in maternal–fetal medicine described by Heuser, Eller and Byrne.

  • Severe fetal anomalies
  • fetus as a patient
  • professional responsibility model of obstetric ethics
  • non-aggressive obstetric management
  • abortion
  • history of health ethics/bioethics
  • paediatric ethics
  • futility
  • ethics in obstetrics and gynaecology
  • history of medical ethics

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  • Competing interests None.

  • Provenance and peer review Commissioned; internally peer reviewed.

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