Weighing the social and ethical considerations of maternal-fetal surgery

Ryan M. Antiel, Alan W. Flake, Christopher A. Collura, Mark P. Johnson, Natalie E. Rintoul, John D. Lantos, Farr A. Curlin, Jon C Tilburt, Stephen D. Brown, Chris Feudtner

Research output: Contribution to journalArticlepeer-review

7 Scopus citations

Abstract

OBJECTIVES: The ethics of maternal-fetal surgery involves weighing the importance of potential benefits, risks, and other consequences involving the pregnant woman, fetus, and other family members. We assessed clinicians' ratings of the importance of 9 considerations relevant to maternal-fetal surgery. METHODS: This study was a discrete choice experiment contained within a 2015 national mail-based survey of 1200 neonatologists, pediatric surgeons, and maternal-fetal medicine physicians, with latent class analysis subsequently used to identify groups of physicians with similar ratings. RESULTS: Of 1176 eligible participants, 660 (56%) completed the discrete choice experiment. The highest-ranked consideration was of neonatal benefits, which was followed by consideration of the risk of maternal complications. By using latent class analysis, we identified 4 attitudinal groups with similar patterns of prioritization: "fetocentric" (n = 232), risk-sensitive (n = 197), maternal autonomy (n = 167), and family impact and social support (n = 64). Neonatologists were more likely to be in the fetocentric group, whereas surgeons were more likely to be in the risk-sensitive group, and maternal-fetal medicine physicians made up the largest percentage of the family impact and social support group. CONCLUSIONS: Physicians vary in how they weigh the importance of social and ethical considerations regarding maternal-fetal surgery. Understanding these differences may help prevent or mitigate disagreements or tensions that may arise in the management of these patients.

Original languageEnglish (US)
Article numbere20170608
JournalPediatrics
Volume140
Issue number6
DOIs
StatePublished - Dec 1 2017

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

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