Current status of negative treatment decision-making for fetuses with a prenatal diagnosis of neonatal surgical disease at a single Japanese institution.
OBJECTIVE
The termination of pregnancy because of fetal abnormalities in Japan has not been described. The aim of the present study was to analyze the current status and to evaluate the medical and ethical relevance in our institution for negative treatment decision-making for fetuses demonstrating neonatal surgical disease with a prenatal diagnosis.


METHODS
The medical records of 209 fetuses with a prenatal diagnosis from 1999 to 2008 were retrospectively reviewed. The cases with a negative treatment policy were analyzed according to the potential for survival. The negative treatment policies were defined as those in which the pregnancy was not actively continued, including elective termination of pregnancy and palliative or limited treatment that are primarily provided after birth.


RESULTS
The selected treatment policies were active in 162 cases and negative in 46 cases. Thirty-three cases with negative policies were in the second-half period of pregnancy. The potential for survival was high in 5 cases, moderate in 11 cases, and nonviable in 30 cases. Eight of the nonviable cases underwent either limited or palliative treatment, whereas the remaining 38 fetuses were aborted.


CONCLUSIONS
The negative treatment policies in the nonviable fetuses were considered to be medically and ethically relevant. However, the number of cases with negative policies increased over the last 5 years and is therefore associated with complex ethical issues.
Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Osaka 565-0871, Japan. usui@pedsurg.med.osaka-u.ac.jp
Noriaki
N
Usui
Takeshi
T
Kanagawa
Masafumi
M
Kamiyama
Gakuto
G
Tani
Yukiko
Y
Kinugasa-Taniguchi
Tadashi
T
Kimura
Masahiro
M
Fukuzawa
D000025:Abortion, Eugenic / Q000523:psychology / Q000706:statistics & numerical data*; D000013:Congenital Abnormalities / Q000175:diagnosis / Q000453:epidemiology*; D003657:Decision Making; D005260:Female; D005865:Gestational Age; D006785:Hospitals, University / Q000706:statistics & numerical data*; D006801:Humans; D007564:Japan / Q000453:epidemiology; D016134:Organizational Policy; D010166:Palliative Care; D011247:Pregnancy; D011296:Prenatal Diagnosis; D011379:Prognosis