Advances in Fetal Surgery Raise Many Issues

By Wendy Pulliam, J.D., LL.M. Candidate

The Wall Street Journal recently printed an article about fetal surgery on fetuses diagnosed with spina bifida. Children born with spina bifida can suffer from physical disabilities such as weakness or paralysis in the legs as well as mental disabilities. Surgeons at Vanderbilt University Medical Center have operated on a number of fetuses in utero in order to close the opening of the spine and minimize further physical and mental damage. Even if malformation of the brain has begun, fetal surgery allows the malformation to correct itself.

When fetal surgery was first attempted, it was only used in cases where fetal death would result if surgery were not performed. Because the effects of spina bifida vary in intensity and it is not a fatal disease, questions have been raised about the use of fetal surgery in cases of spina bifida.

Critics say that parents are willing to ignore the risks of fetal surgery in an effort to have a perfect child. The risks include injury to the mother, injury to the fetus, premature birth, or even fetal death.

Parents counter critics by saying that before the use of fetal surgery for spina bifida, parents were given just two options. These options were abortion or giving birth to a disabled baby. Fetal surgery gives parents more options. Parents also argue that upon birth babies diagnosed with spina bifida have immediate surgery to close the opening in the spine. Fetal surgery simply alters the timing of the surgery to minimize the physical and mental affects of the disease. What parent would not want to allow his/her child to live a life as free from physical and mental impairment as possible?

Another issue raised by fetal surgery is that some insurance companies have called this type of surgery experimental. Parents hope that insurance companies will realize that fetal surgery makes fiscal sense and begin to approve the procedure. Fetal surgery for spina bifida typically costs $25,000 to $30,000. An insurance company can spend that in the first year of the life of a baby born with spina bifida.

Critics also worry that as fetal surgery becomes more routine and medical technology continues to advance, doctors will make the fetus a patient at the expense of the mother's autonomy. There are already cases in which physicians have attempted to force women to have cesarean sections against their will for the good of the baby. Will women be forced to have fetal surgery against their wishes for the good of the baby? Does the women have to offer reasons for her refusal or can she simply refuse? If she has to offer reasons, the physician is then placed in the position of having to evaluate the mother's reasons. How can one person objectively evaluate such highly personal and subjective reasoning? Does a fetus have an interest in being born as free from physical and mental disabilities as possible?

Fetal surgery to correct and minimize medical problems is a fascinating field. It offers hope to many, but it also raises important issues that need to be further examined in detail.

06/14/99