Prenatal detection and fetal surgery of clefts and craniofacial abnormalities in humans: social and ethical issues.

Sophisticated prenatal diagnostic imaging has facilitated the progression of fetal surgery from the experimental possibility to a clinical therapy for several life-threatening congenital conditions. Guidelines for such fetal surgery include the expectation that the child will be reasonably healthy as a result and that the in utero approach will improve the outcome or is safer than postnatal intervention. Prenatal ultrasound detection of craniofacial anomalies is now common. Reports of experimental cleft repairs in animal fetuses suggest advantages including diminished scarring, improved health and nursing. While fetal craniofacial surgery has not been attempted in humans, speculations exist about the psychological and social benefits of being born with a repaired defect. Fetal surgery is an emerging technology that may alter experimentation, cleft treatment, and the allocation of scarce resources. This paper examines the social and ethical implications of prenatal diagnosis and fetal surgery, focusing on fetal/maternal rights, and clinical decision making.