Ethical problems in cardiac surgery for a lethal, congenital malformation.

The development of surgical procedures for increasingly complex and hitherto considered to be fatal and noncorrectible congenital heart disease has resulted in a re-evaluation of the ethical and social issues raised by the availability of such procedures. Three specific cases are used to illustrate some of the problems that may arise in different socioeconomic and geographic groups. It is suggested that the mere availability of the procedure does not necessarily either allow for or permit its logistical use without attention to the underlying ethical and social conditions.