Prenatal Counseling for Maternal–Fetal Surgery

This chapter analyzes potential biases and competing interests in prenatal counseling when conditions are diagnosed for which intrauterine surgery may be possible. Such counseling often occurs at the multidimensional interface of obstetrics and pediatrics. After considering clinical, social, and historical contexts of such counseling, the chapter presents a case that illustrates how physician demographics, interspecialty differences, divergent clinical experiences, and larger organizational factors may compound practice variation. It considers how biased counseling may influence patients’ decisions and questions whether value-neutral counseling is attainable when such fetal conditions are diagnosed. It concludes that declared commitments to value neutrality cannot insulate pregnant patients from biases and competing interests. In its recommendations, it discusses organizational responses analogous to conflict-of-interest policies. It further suggests that conversations between clinicians and patients that are mutually open about values may enhance rather than undermine patients’ ability to formulate decisions that most closely embody their true preferences.