Fetal intracardiac potassium chloride injection to avoid the hopeless resuscitation of an abnormal abortus: II. Ethical issues.
Following the diagnosis of a genetic anomaly, some couples choose to have a legal abortion. However, following later abortions at greater than 20 weeks, the rare but catastrophic occurrence of live births can lead to fractious controversy over neonatal management. To avoid this situation, we have added fetal intracardiac potassium chloride injection to cause fetal cardiac arrest before induction of labor. The ethical issues surrounding such a practice are complex. We support this practice for three reasons: 1) The women's decision for abortion is protected because this practice assures her right for non-interference; 2) potential psychological harm to the patient and other family members is avoided; and 3) the potential for coercive intervention by other health care personnel is eliminated. At least three objections can be raised: 1) All abortions are unjust; 2) newborns and second-trimester fetuses at similar weights with identical defects should be managed in like fashion; and 3) the patient is not entitled to death of the fetus, only to evacuation of the uterine contents. On balance, we believe that our approach is justifiable ethically as it reduces the burden of conflict between the wishes of the patient and those of the neonatal care givers. It should be introduced only in situations in which the likelihood of civil or criminal liability or unwarranted medical intervention is high.
Fletcher
J C
JC
Center for Biomedical Ethics, University of Virginia Health Sciences Center, Charlottesville.
Isada
N B
NB
Pryde
P G
PG
Johnson
M P
MP
Evans
M I
MI
D000025:Abortion, Eugenic; D000013:Congenital Abnormalities / Q000628:therapy; D004992:Ethics, Medical; D005260:Female; D005318:Fetal Heart; D006324:Heart Arrest, Induced; D006801:Humans; D007267:Injections; D007751:Labor, Induced; D011189:Potassium Chloride / Q000008:administration & dosage*; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D012151:Resuscitation
D011189:Potassium Chloride