March 10, 2000

Conference set to probe fetal surgery ethical issues

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A national conference here will explore ethical questions surrounding fetal surgery. (photo by Anne Rayner)

Conference set to probe fetal surgery ethical issues

During the last three years Vanderbilt University Medical Center has become a national leader in the field of in utero surgery for spina bifida — performing more than 80 of the procedures that attempt to minimize possible future damage by operating on fetuses while still developing in the womb.

The challenges facing the procedure include not only physical limitations in the operating room, but also the moral and ethical questions families wrestle with when choosing whether to do the surgery.

A national conference tackling these questions will be held at Vanderbilt University's Davis K. Wilson Hall tomorrow and Sunday, March 11 and 12.

The conference will feature presentations by leading experts in the fields of fetal surgery, ethics, law, sociology, and theology as well as panel discussions and interactive audience participation.

“Given that fetal surgery for spina bifida is elective, it deserves special consideration regarding its known risks and, at this point, unknown benefits," said Mark Bliton, Ph.D., assistant professor of Medicine. "This conference will be an attempt to bring out the complexities of these issues and examine them within a number of disciplines.”

Topics covered during the conference will include: the fetus as a patient, the moral ramifications of elective operations on pregnant women, and what factors determine a beneficial outcome. Participants will discuss the minimum standards and steps for counseling those patients considering surgery for non-lethal fetal malformations.

When Dr. Joseph P. Bruner, director of Fetal Diagnosis and Therapy, and Dr. Noel B. Tulipan, associate professor of Neurosurgery, initially performed the spina bifida operation it was the first time surgeons had attempted an open-fetal surgery for any condition that was not life threatening. Not only would the mother and baby have lived if the surgery had not been done, but the benefits of such a procedure were, at that point, undefined.

Medical ethicists were included on the fetal surgery team, which designed a counseling process to ensure that women and couples considering the surgery were as informed as possible and also to learn about the way that couples decide to undergo this type of procedure.

During the last three years Bliton and Richard Zaner, Ph.D., Ann Geddes Stahlman professor of Medical Ethics, were able to study the many ways families come to grips with the risks and rewards of the surgery.

“The process has been enriching not only for us but also, I believe, for the patients who go through our consultation," Bliton said. "During the sessions we discuss some of the deeply personal issues that we think couples need to contemplate before deciding to undergo the procedure,” said Bliton.

Over time, Bliton and Zaner began to notice patterns in the decision-making processes.

“Most of these couples were people with religious conviction and faith in God and many believe that God has guided their choice about whether to have the surgery or not,” said Bliton.

After three years of compiling information about couples visiting VUMC, the Fetal Surgery Team has decided it is time to explore these ethical issues with a panel of medical experts.

In addition to VUMC’s fetal surgery team, the conference will feature Monica Casper, Ph.D., assistant professor of Sociology at the University of California, Santa Cruz; Albert Jonsen, Ph.D., visiting professor of Political Science at Yale University; Mary Mahowald, Ph.D., professor of Ob-Gyn at the University of Chicago; David Thomasma, Ph.D., director of the medical Humanities Program at Loyola University; and Susan Wolf, professor of Law and Medicine at the University of Minnesota.

For more information about the conference, call 322-4030.