Fetal surgery: doing more, raising more questions

By Elizabeth Cooney, Globe Correspondent

Fetal surgeons can heal the tiniest bodies imaginable, repairing heart defects, rerouting circulation, or restoring organs to their proper places before birth. But as imaging, intensive care, and surgical techniques have leapt forward, they have brought new ethical questions with them.

Does the pregnant woman have a duty to allow a medical procedure that might help the fetus she is carrying? How does her risk weigh against any obligation to the future child? What conditions are serious enough to warrant risk to the woman and the fetus?

At a Harvard Medical School forum Wednesday, Dr. Russell Jennings, head of fetal surgery at Children's Hospital Boston, showed about 50 people how far his specialty has come in the past 20 years. He also flatly and firmly stated his opinion on who his patients are.

"Mom isn't just a vessel," he said. "Whatever we do, we have to go through her in some way. It is incumbent on us to minimize the risk."

Fetal surgery carries risk for both mother and child, with four maternal deaths reported around the world, Jennings said. Some procedures have not proven better than ones that can be delayed until after birth.

R. Alta Charo, a professor of law and bioethics at the University of Wisconsin at Madison, said there is public horror at the thought of a fetus being born with a condition that could be avoided, but she also asked how far society should go in the notion of a healthy child. Socioeconomic forces can influence a child's overall welfare as much as medical ones, she said, using early childhood education as an example.