Ethical issues in fetal surgery.

Fetal surgery involves unique ethical issues because the interests of fetus and mother may conflict but, regardless, they are inextricably interconnected. Controversial questions currently include what kinds of surgery should be permitted, who should decide, and whether this surgery should be restricted to specialized centers. Clinical questions include the degree to which mothers should have decision-making authority, the extent, if any, to which mothers should be protected from pressure from family members, and whether physicians should be non-directive. This article discusses these questions and their answers' competing rationales. It also presents recent data from attachment studies of mothers and infants and from neuroscience, which suggest that mothers and infants are more interdependent physiologically and psychologically than has been understood. The paper describes how these findings may apply to the mother and fetus long before it is born. The major implication of this analysis is that mothers should, perhaps, have greater decision making authority.