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Advanced Fetal medicine and Therapeutics

₹ 1000.00

Category
Medical CME Programs

  • Duration 90 Days
  • Modules 28

Doctor Responsible for Risk Assessment and Treatment

Fetal therapy is a highly specialized field of medicine, and it is becoming increasingly more difficult to apply the principle of the duty of reasonable care in the circumstances. The drawing of the line between when fetal therapy should and when it should not be offered is a moral dilemma that doctors and pregnant women have to face. More than one evaluation of the risks by the doctor and the mother could be reasonable, without one or the other being unreasonable. Medicine is not an exact science. Errors may be made in good faith without any suggestion of incompetence or the need of legal actions for negligence. Creating a climate in which doctors are unreasonably fearful of being sued for damage hinders the making of good clinical decisions for the fetus, the mother, and the family. Doctors should only be liable for damages for harm done to the mother or the unborn child if it is proven that they have been professionally negligent, not because the mother needs financial support for a disabled child. The State should make other provisions for such cases of hardship, such as a fully funded national no fault disability insurance scheme.

Successful fetal therapies require accurate diagnoses and knowledge of the relevant fetal pathophysiology in each case. This requires a careful evaluation of the fetus in addition to a precise anatomical definition of the malformation under consideration. The timing of the intervention should not be so early as to endanger the fetus nor so late as to make it futile. It is important to save the mother from being subjected to unnecessary invasive fetal therapies. Most fetal defects or anomalies are best treated after birth by the appropriate medical therapy. If required, the fetal age selected for premature delivery and treatment ought to be whatever is in the best interests of the mother and the fetus, including management after elective cesarean delivery.

Consultation among colleagues may facilitate the task of assessing the risk of harm to the fetus resulting from fetal therapy against the burden of malformation for a lifetime if no treatment is given. The probability of success would need to be sufficiently high to justify fetal therapy where the risk to the life of the fetus was substantial. Under no circumstances, not even at the request of the mother, should doctors act against their conscientious judgment by giving fetal treatment that is not in the best interests of their patients – the pregnant woman and her fetus. At other times, doctors may need to reassure parents that no intervention is in the best interests of both mother and fetus.