title: Trisomy 18 and complex congenital heart disease: seeking the threshold benefit.
abstract: A prenatal diagnosis of ductal-dependent, complex congenital heart disease was made in a fetus with trisomy 18. The parents requested that the genetic diagnosis be excluded from all medical and surgical decision-making and that all life-prolonging therapies be made available to their infant. There was conflict among the medical team about what threshold of neonatal benefit could outweigh maternal and neonatal treatment burdens. A prenatal ethics consultation was requested.
authors.affiliation: Department of Pediatrics, Johns Hopkins University School of Medicine, Johns Hopkins University School of Nursing, Baltimore, MD, USA. rboss1@jhmi.edu
authors.forename: Renee D
authors.initials: RD
authors.lastname: Boss
authors.forename: Kathryn W
authors.initials: KW
authors.lastname: Holmes
authors.forename: Janyne
authors.initials: J
authors.lastname: Althaus
authors.forename: Cynda H
authors.initials: CH
authors.lastname: Rushton
authors.forename: Hunter
authors.initials: H
authors.lastname: McNee
authors.forename: Theresa
authors.initials: T
authors.lastname: McNee
mesh_terms: D000025:Abortion, Eugenic; D000818:Animals; D002585:Cesarean Section / Q000941:ethics; D002887:Chromosomes, Human, Pair 18 / Q000235:genetics*; D003299:Cooperative Behavior; D017281:Cost of Illness; D004310:Double Outlet Right Ventricle / Q000175:diagnosis* / Q000235:genetics* / Q000628:therapy*; D004452:Echocardiography; D033061:Ethics Consultation; D004992:Ethics, Medical; D005260:Female; D005313:Fetal Death; D005317:Fetal Growth Retardation / Q000175:diagnosis; D006352:Heart Ventricles / Q000002:abnormalities*; D006801:Humans; D007231:Infant, Newborn; D033183:Interdisciplinary Communication; D008020:Life Support Care / Q000941:ethics; D033282:Parental Consent / Q000941:ethics; D011247:Pregnancy; D011296:Prenatal Diagnosis / Q000941:ethics*; D012068:Religion and Medicine; D018570:Risk Assessment; D016312:Treatment Refusal; D014314:Trisomy; D016216:Ultrasonography, Prenatal
keywords: cardiac surgery; decision-making; ethics; trisomy 18