The Ethics of Implementing First-trimester Risk Assessment
Laurence B McCullough
Keywords :
Ethics,physician as fiduciary,professional virtues,ethical principles,first trimester risk assessment,conflict of interest
Citation Information :
McCullough LB. The Ethics of Implementing First-trimester Risk Assessment. Donald School J Ultrasound Obstet Gynecol 2008; 2 (2):57-61.
First trimester risk assessment has become a reliable screening tool for trisomy 21, replacing age-based risk assessment. On the basis of the ethical concept of the physician as fiduciary, the professional virtues of integrity and self-sacrifice, and the ethical principles of respect for autonomy, beneficence, and justice, we argue that the obstetrician has an ethical obligation to routinely offer pregnant women first trimester risk assessment in high quality centers. We then argue that both obstetricians and specialists in risk assessment have a strict ethical obligation to identify, responsibly manage, and disclose both economic and non-economic conflicts of interests, especially when they are hidden Ethics is an essential dimension of implementation of first trimester risk assessment for trisomy 21.
Ethics in Obstetrics and Gynecology. New York, Oxford University Press, 1994.
Prenatal informed consent for sonogram: an indication for obstetric ultrasonography. Am J Obstet Gynecol 1989;161:857-60.
Ethics and routine ultrasonography in pregnancy. Am J Obstet Gynecol 1990;163:257-58.
Prenatal informed consent for sonogram: the time for firsttrimester nuchal translucency has come. J Ultrasound Med 2001;20:1147-52.
Firsttrimester nuchal translucency screening: reply. J Ultrasound Med 2002;21:481,483-87.
Nuchal translucency and other first-trimester sonographic markers of chromosomal abnormalities. Am J Obstet Gynecol 2004;191:45-67.
Prospective screening for trisomy 21 in 30,564 pregnancies in a one stop clinic at 11-13 weeks. Am J Obstet Gynecol 2005;192:1761-67.
First-trimester screening for trisomies 21 and 18. N Engl J Med 2003;349:1405-13.
First-and second-trimester evaluation of risk (FASTER) trial: Principal results of the NICHD multicenter Down syndrome screening study. Am J Obstet Gynecol 2003;S56 (abstract).
Committee on Practice Bulletins. Screening for fetal chromosomal abnormalities. Obstet Gynecol 2007;109:217-27.
Implementation of firsttrimester risk assessment for trisomy 21: ethical considerations. Am J Obstet Gynecol 2005;192: 1777-81.
Natural law and medical ethics in the eighteenth century. In Baker R, Porter D, Porter R (Eds): The Codification of Medical Morality: Historical and Philosophical Studies of the Formalization of Western Medical Morality in the Eighteenth and Nineteenth Centuries. Volume One: Medical Ethics and Etiquette in the Eighteenth Century. Dordrecht, The Netherlands: Kluwer Academic Publishers, 1993;123-39.
Medical Ethics in the Renaissance. Washington, DC: Georgetown University Press, 1995.
John Gregory and the Invention of Professional Medical Ethics and the Profession of Medicine. Dordrecht, The Netherlands, Kluwer Academic Publishers, 1998.
Medical ethics in early modern England in Wear A, Geyer-Kordesch J, French P (Eds): Doctors and Ethics: The Earlier Historical Setting of Professional Ethics. Amsterdam and Atlanta, Rodopi, 1993;98-130.
Patient consent and negotiation in the Brooklyn gynecological practice of Alexander JC Skene: 1863-1900. J Med Philos 2000;25:12-27.
Principles of biomedical ethics. (5th edn). New York: Oxford University Press 2001.
Argumentbased medical ethics: a formal tool for critically appraising the normative medical ethics literature. Am J Obstet Gynecol 2004;30:659-64.
A History and Theory of Informed Consent. New York: Oxford University Press, 1986.
Clinical implications of the ethics of informed consent for first-trimester risk assessment for trisomy 21. Seminars in Perinatol 2005;29:277-79.
Evidence-based obstetrical ethics and informed decision-making by pregnant women about invasive diagnosis after first trimester assessment of risk for trisomy 21. Am J Obstet Gynecol 2005;193:322-26.
Efficacy of screening for fetal Down syndrome in the United States from 1974 to 1997. Obstet Gynecol 2000;96979-85.
Sequential Pathways of Testing After First-Trimester Screening for Trisomy 21. Obstet Gynecol 2004;104:661-66.
Patients’ preferences regarding first trimester aneuploidy risk assessment. Am J Obstet Gynecol 2005;193:1429-36.
Women's opinions and the implications of first-versus second-trimester screening for fetal Down's syndrome. Prenat Diag 1997;17:1011-18.
Women's knowledge of and attitudes to first and second trimester screening for Down's syndrome. Brit J Obstet Gynecol 2000;107:1302-05.
Nuchal translucency and the acceptance of invasive prenatal chromosomal diagnosis in women aged 35 and older. Obstet Gynecol 2001;97:916-20.
Is nuchal translucency screening associated with different rates of invasive testing in an older obstetric population? Am J Obstet Gynecol 2004;190:769-74.
The threat of the new managed practice of medicine to patients’ autonomy. J Clin Ethics 1995;6:320-23.
Responding to the ethical challenges of managed care in the practice of obstetrics and gynecology. Am J Obstet Gynecol 1996;175:523-27.
Understanding, assessing and managing conflicts of interests. In McCullough LB, Jones JW, Brody BA (Eds): Surgical Ethics. New York: Oxford University Press 1988:342-66.
