Ethical Issues in Intrauterine Myelomeningocele Surgery

Abstract

Intrauterine surgery shows that the prognosis of neonates with myelomeningocele (MMC) has improved, both in survival and in quality of life. In order to study the current efficacy of intrauterine surgery for MMC and to make an ethical analysis of its proportionality, we conducted a PubMed search using the keywords “myelomeningocele”, “intrauterine surgery”, “MOMS”, and “trial”. Thirty-eight articles were found. The literature investigated the risks and benefits of intrauterine surgery based on the physiological parameters of MMC. Intrauterine surgery produces clear benefits. However, it also has disadvantages, such as premature birth, fetal or neonatal death, and uterine complications. The option of surgery is positive. However, since the intervention is risky, the final decision must be prudential, and thus should involve an ethical analysis of therapeutic proportionality. This requires a specific clinical evaluation of the fetus ensuring fetal survival in all cases and minimizing the risks arising from extremely premature birth.

KEYWORDS:

• ethics
• myelomeningocele
• intrauterine surgery
• treatment

Notes on contributors

Agustín Silberberg received the Medical Doctor degree from Universidad Católica de Córdoba, Argentina; he is Specialist in Internal Medicine from Universidad Nacional de Buenos Aires, Argentina; he received the ph.D in Medicine from Universidad Austral, Buenos Aires, Argentina; He received the ph.D in Theology from Pontificia Università della Santa Croce, Rome, Italy; he is Member of the Department of Bioethics in the Hospital Universitario Austral, Buenos Aires, Argentina.

Josefina Robetto received the medical degree from Austral University, Buenos Aires, Argentina, in 2015. From 2015 to 2017, she worked in the coordination area of the NGO Impulso Social. She is currently working for the Fisiopatology and Bioethics departments of Austral University of medicine. Her research interests include bioethical aspects of neurological deseases, proporcionality of treatments, end of life matters, etc.

Magdalena Grillo is currently in her last year of medical school at the Austral University, Buenos Aires, Argentina. Her research interests include psychiatric pathology from a biological and welfare perspective and ethical aspects of disabling pathologies.