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Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,Fetus with a Lethal Condition,Ma.Teresa C.Ambat,MD,PL 3 Pediatric Resident,Infant Mortality Rate,Ethical Basis of Screening for Fetal Anomalies,Why offer screening for fetal anomalies?,Legal considerations,Ethical considerations,Ethical Basis of Screening for Fetal Anomalies,In 1974,Shirley Berman was a 38-year old pregnant patient under the care of two OBs in NJ.The,pregnancy culminated with the delivery of a child with Down Syndrome.,Mrs Berman claimed that her physicians had not informed her,that her age put her at increased risk for having a child with DS or that amniocentesis was available for determining whether the fetus had this condition.,Ethical Basis of Screening for Fetal Anomalies,Failure to provide the information in question resulted in Mrs Berman being deprived of the opportunity to make decision about whether to terminate the pregnancy.,“defendants directly deprived her and,derivatively,her husband of the option to accept or reject a parental relationship with the child,“caused them to experience mental and emotional anguish upon their realization that they had given birth to a child afflicted with Down syndrome,Ethical Basis of Screening for Fetal Anomalies,Ethical duty to provide information about screening is based in part on,respect for the autonomy of pregnant women and their partners,Reproductive freedom:,freedom to procreate,freedom not to procreate,freedom not to gestate,freedom to terminate ones pregnancy,Ethical Basis of Screening for Fetal Anomalies,The autonomy of pregnant women and their partners is promoted when they are provided,information relevant to decisions about whether to continue a current gestation,Facts about health status of the fetus,the presence or absence of anomalies and the implications of anomalies for the child and the family,Ethical Basis of Screening for Fetal Anomalies,Principle of beneficence,Physicians should strive to promote the well-being of patients by removing and preventing harms,“Raising children with anomalies can create special burdens,that for some families substantially reduce the familys quality of life,Ethical Basis of Screening for Fetal Anomalies,In providing information about screening,physicians not only,promote autonomy,but also give the pregnant woman and her partner the,opportunity to make their decisions,about what would best promote the well-being of their family,Providing Emotional Support,Physicians have a duty to provide emotional support,Principle of beneficence:prevent and remove health-related harms to their patients,Pregnant patients who are experiencing emotional distress related to fetal anomalies have a need for help in reducing and preventing such distress,The physician is in a position to offer such help,Giving Bad News,When testing reveals that fetus has an anomaly,The physician has the duty not only to give information but also do so in a manner that provides emotional support,The ability to communicate well and with compassion,Many physicians receive little or no training in giving bad news and feel uncomfortable doing so,Giving Bad News,Effective ways to deliver bad news,A meeting is scheduled in advance for the purpose of discussing test results,In other situations,results are communicated to the patient immediately after a test,In either situation,the patient should be offered the opportunity to bring her partner or another significant person with her,Giving Bad News,The physical setting should be a place that is conducive to having a discussion-,architecturally private and relatively quiet place,Set aside,sufficient time,for the meeting to permit information to be given,to answer questions and to respond to emotional reactions,Discussion:information about the test results,the nature of the fetus medical problem and prognosis,Giving Bad News,Clarity in conveying information is important,Use terms that patient can understand,Avoid too much medical details,Proceed at a pace that is conducive to patient comprehension,How much to tell at one time varies,Patients and partners should be encouraged to ask questions,Giving Bad News,Communicate concern and support,Physician should sit at the same level as the patient,as opposed to standing over them,Eye contact,facial expressions and body language are important and can be used to communicate a caring attitude,Physicians should show their feelings,Should reassure the patient that good care will continue and that her medical needs will be met,Giving Bad News,Communicate concern and support,It is acceptable to show concern by touching the patient such as holding or gripping hands,If the patient cries,expressions of sympathy followed by a period of silence might be appropriate,Giving bad news face to face is preferable to giving it over the tele
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