Ethical considerations in prenatal surgical consultation

When pediatric surgeons counsel the prospective parents of a fetus with a m ajor congenital anomaly, medical and ethical issues may arise in one or mor e contexts. There may be: (1) issues concerning the possibility of in-utero intervention or termination of pregnancy; (2) issues surrounding the timin g, location and mode of delivery; and (3) issues concerning possible operat ive interventions after the birth. The virtues of compassion, honesty, and integrity should guide the surgeon in helping the parents confront the diag nosis of a fetal malformation. The ethical principles that inform the prena tal consultation should include respect for autonomy, reproductive freedom, beneficence, and justice. Ethical conflict may develop if the pregnant wom an chooses a course of action that is inconsistent with traditional pediatr ic surgical recommendations.