Nonaggressive obstetric management was used in 13 cases of anomalous fetuses during the third trimester. Criteria that define these anomalies are (1) a very high probability of a correct diagnosis and (2) either (a) a very high probability of death as an outcome of the anomaly diagnosed or (b) a very high probability of severe and irreversible deficit of cognitive developmental capacity as a result of the anomaly diagnosed. On the basis of two approaches to obstetric ethics, we defend the legitimacy of nonaggressive management of third-trimester pregnancies complicated by fetal anomalies that meet these criteria.
KIE: Chervenak and McCullough contend that, in third trimester pregnancies with anomalies in which there is (1) a very high probability of a correct diagnosis and (2) either (a) certainty of death as an outcome of the anomaly or (b) in some cases of short-term survival, certainty of the absence of cognitive developmental capacity as a result of the anomaly, nonaggressive obstetric management is a legitimate approach because intervention has little to offer the fetus. The authors argue that nonaggressive intervention can be defended both by those that advocate respect for the autonomy of the pregnant woman and by those who view the ethical principles of respect for autonomy and beneficence, and the duties they generate, as prima facie or theoretically equally weighted principles. Aggressive intervention is not required because the obligations to the third trimester fetus are only minimal in such cases; indeed, beneficence may even argue against aggressive intervention.