Physicians comply with patient wishes over severe fetal anomalies

By Sarah Guy

Study results indicate that physicians respect patient autonomy in the case of uniformly and commonly lethal fetal anomalies, respecting the wishes of parents in how to manage the pregnancy.

However, the study authors note that patients may be offered different options for management of fetal anomalies according to practitioner demographics.

For example, female physicians were more likely than male physicians to encourage nonintervention in cases of fetal anomaly rather than to discourage intervention or be nondirective.

"Obstetricians have begun to talk about what we should do, but few data exist on what we as a community actually do in practice," say Cara Heuser (University of Utah, Murray, USA) and colleagues.

"It is important... to know how the community as a whole approaches these issues. Such information defines areas of consensus and highlights those in which substantial discrepancies occur," they add in the Journal of Medical Ethics.

A total of 732 members of the US Society of Maternal-Fetal Medicine responded to Heuser and co-workers' questionnaire assessing obstetric management of uniformly (eg, anencephaly, renal agenesis) and commonly (eg, trisomy 13 and 18) lethal fetal anomalies. Respondents were asked to answer as if not limited by state or institutional restrictions.

Nearly all physicians reported discussing termination in both uniformly and commonly lethal cases of abnormality, and approximately half overall (45% and 59%) would restrict termination by gestational age.

Similarly, almost all respondents said they would comply with parents who wished to continue the pregnancy with no intervention to maximize the changes of a live birth.

The majority of respondents ‑ specifically 71% in the context of uniformly lethal and 82% in commonly lethal abnormalities ‑ reported that they would comply with parents who did request full obstetric intervention to increase the chances of live birth.

"Some women will want to have the opportunity to have their child born alive for a variety of reasons, including helping with the grieving process," say the authors.

In adjusted analysis, the researchers observed significant demographic differences in physician responses, including women being significantly more likely than men to encourage nonintervention in uniformly lethal anomalies.

Differences also existed in termination methods offered, with physicians in academic practice significantly more likely to offer induction or dilation and evacuation, rather than offering a single option or referral to another provider.

While each circumstance potentially requires a different course of action, "prospective guidelines regarding the management of these patients may help patient counselling and management options," conclude Heuser et al.

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