The legal frameworks that govern fetal surgery in the United Kingdom, European Union, and the United States

Abstract

The specialty of fetal surgery or fetal intervention is one of the most exciting emerging fields of modern medicine. It is made possible by decades of major developments in antenatal imaging, obstetric anaesthesia, fetal medicine, paediatric surgery, and of course by the bold and novel practitioners willing to take new steps to advance the field. Beginning in the 1970s, it has now reached a stage of maturity where there are several established in utero procedures and countless clinical trials and studies to develop more. But what is the legal situation that fetal surgeons find themselves in? What are the rights and legal protections for the fetus and the mother, both of which are arguably the patient? This article will address this question, discussing and summarising the current legal frameworks governing fetal surgery in the jurisdictions of the United Kingdom, European Court of Human Rights, and the United States of America as well as discuss what the future may hold and how researchers and physicians in the specialty can best navigate the legal environment.

‘We did everything we could’– a qualitative study exploring the acceptability of maternal‐fetal surgery for spina bifida to parents

“…[1][2][3][4][5] Following antenatal diagnosis of open SB, prospective parents face a range of uncertainties regarding the future of their unborn child, and the options provided pose major ethical challenges. 6 In this situation parents frequently choose termination of pregnancy (TOP), as opposed to expectant prenatal management (EM) followed by postnatal assessment and surgery. 7,8 MFS provides now an additional third option in which antenatal coverage of the fetal neural tissue is undertaken to prevent further damage.…”

“…Maternal‐fetal surgery (MFS) for open spina bifida (SB) has the potential to improve long‐term outcomes but at significant procedure‐related fetal and maternal risk 1‐5 . Following antenatal diagnosis of open SB, prospective parents face a range of uncertainties regarding the future of their unborn child, and the options provided pose major ethical challenges 6 . In this situation parents frequently choose termination of pregnancy (TOP), as opposed to expectant prenatal management (EM) followed by postnatal assessment and surgery 7,8 .…”

Envisioning treating genetically-defined urinary tract malformations with viral vector-mediated gene therapy

“…As outlined in the International Fetal Transplantation and Immunology Society's Consensus Statement on In Utero Gene Therapy, human fetal gene therapy could become a reality in the next decade [56]. Moreover, although legal aspects of fetal therapies differ between and even within countries [57], it has been reasoned that there would be no major ethical or social constraints for fetal gene therapy for diseases that would untreated lead to death or severe morbidity [58]. Of note, although not a gene therapy trial, the amelioration of hypohidrotic ectodermal dysplasia, a rare genetic skin disease, was successful after administering recombinant protein into the amniotic cavities of two human fetuses [59].…”

The right to life of a fetus: Abortion is a serious moral and social problem of the young people in Vietnam

“…When talking about the rights of the fetus, Cao et al (2018) definite that fetal rights are the moral rights or legal rights of the human fetus under natural and civil law. Regarding the right to life of the fetus, although there are currently conflicting views.…”