Hindawi Publishing Corporation International Journal of Pediatrics Volume 2010, Article ID 857460, 6 pages doi:10.1155/2010/857460 Review Article Ethical Issues in Fetal Management: A Cardiac Perspective Atul Malhotra,1 Samuel Menahem,2, 3, 4 and Lynn Gillam4, 5 1 Department of Neonatology, Monash Medical Centre, 246, Clayton Road, Clayton, Melbourne, Victoria 3168, Australia 2 Fetal Cardiac Unit, Monash Medical Centre, 246, Clayton Road, Clayton, Melbourne, Victoria 3168, Australia 3 Departments of Pediatrics & Psychological Medicine, Monash University, Melbourne, Victoria 3168, Australia 4 Murdoch Children’s Research Institute, Melbourne, Victoria 3052, Australia 5 Children’s Bioethics Centre, Royal Children’s Hospital, Melbourne, Victoria 3052, Australia Correspondence should be addressed to Samuel Menahem, samuel.menahem@southernhealth.org.au Received 15 December 2009; Accepted 23 February 2010 Academic Editor: Wayne Tworetzky Copyright © 2010 Atul Malhotra et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The ethical issues behind the management of a fetus with a serious abnormality and the decisions made in relation to the outcome of the pregnancy are complex. This reﬂective paper deals with the ethical principles of managing a pregnancy with a congenital anomaly, with particular emphasis on the fetus with a serious cardiac abnormality. One major ethical concern is whether the fetus is or is not independent being to whom obligations of beneﬁcence are owed. We review the debate on this matter, and suggest that it is ethically more appropriate for physicians who are involved in management of fetal abnormality not to adopt and insist on their own position on this matter. Rather, the appropriate course is to respect the pregnant woman’s own view of her fetus and how it should be regarded. This is an application of the principle of respect for autonomy. Within this framework, we discuss the diﬃculties in counselling a pregnant woman or expectant couple in this situation, and recommend three key steps in ethically sound counselling. 1. Introduction Prenatal diagnostic ultrasound is widely performed espe- cially in the western world. Parents attending a scan expect to be told that their baby is normal. They want to be reassured regarding the size and well-being of the infant, and may wish to know its sex [1]. When a possible anomaly is identiﬁed, it comes as a shock to the parents, who were not expecting such an outcome. If the anomaly is subsequently conﬁrmed, there may be an assumption that as the parents sought screening in the ﬁrst place; they intended to proceed to an abortion [2]. However, this is not always the case, given their expectations at the outset. Counseling the parents in such situations is complex and requires much sensitivity. This paper reviews the ethical issues involved and makes recommendations for practice. 2. Basic Ethical Principles Chervenak et al. have very eloquently described the basic ethical principles in the management of pregnancies com- plicated by fetal anomalies [3]. The ﬁrst ethical concept is that of beneﬁcence. Health related interests of the patient obligate the physician to seek clinical beneﬁts over clinical harms for the patient. The second basic ethical principle is respect for the patient’s autonomy. This principle means that the patient’s perspective on health-related and other interests is paramount. The physician needs to respect the patient’s own set of values, beliefs and decision-making capacity. The physician’s role is to provide adequate information and a recommended management plan, or range of possible plans, for the condition in question. It is vital that the information is provided in a manner that allows the patient to understand it, so as to be able to reach an informed and voluntary decision. We will discuss the physician’s ethical obligations in relation to informed consent in more detail below. However, it is important to note that the expectant parents’ great state of distress, grief or shock may make it very diﬃcult for them to take in, understand and assimilate what is provided [4], even with very careful presentation of information. The crucial ethical question in pregnancies complicated by fetal anomalies, according to Chervenak et al. [3], is whether the fetus counts independently as a patient to whom the obligations of beneﬁcence are also owed (in addition