title: Maternal-fetal surgery for treatment of myelomeningocele.
abstract: Maternal-fetal surgery for repair of fetal MMC is experimental treatment for which ethically justified clinical trials are not yet possible because equipoise is not established on medical or nonmedical grounds. We have focused here on only two of the important questions raised by this surgery. At least three others might have been considered. First is the question of access to the surgery. MMC is available only to those who can afford it. Given its poor results, that may be a good thing. However, if it were ever proved successful, it should be covered for the poor and affluent women who desire it. Second is the question of the autonomy of the women who seek the procedure. Although the women who undergo the surgery at Vanderbilt are counseled extensively by bioethicists, the autonomy of their decisions may be compromised by pressures from partners or others who think that any risk for the sake of a potential child is fully warranted. Third is the issue of potential discrimination against people with disabilities. Seeking or providing surgery that introduces the risk of fetal demise, a risk that could be avoided by postponing the surgery until after birth, suggests that life with disability is regarded as worse than death. Each of these questions deserves careful, critical analysis in its own right. Along with those addressed in this article, these issues are applicable to other ethical issues in perinatology, including those examined by other contributors to this issue.
authors.affiliation: Department of Obstetrics and Gynecology, Center for the Study of Medical Ethics and Humanities, Duke University Medical Center, Baker House 248, Durham, NC 27710, USA. lyer1003@mc.duke.edu
authors.forename: Anne Drapkin
authors.initials: AD
authors.lastname: Lyerly
authors.forename: Mary B
authors.initials: MB
authors.lastname: Mahowald
mesh_terms: D005260:Female; D005315:Fetal Diseases / Q000601:surgery*; D005333:Fetus / Q000601:surgery*; D006801:Humans; D008591:Meningomyelocele / Q000601:surgery*; D028701:Patient Rights / Q000941:ethics / Q000331:legislation & jurisprudence; D028723:Personhood; D011247:Pregnancy; D037841:Pregnant People