[Fetal life] [Expenses] [Survival] [Termination] [Natural Selection] [The Mother's Story] [What can we treat ?]

IS THE FETUS "ALIVE" ?

All of us are ALIVE. Yet when called upon to define the term "LIFE", how many of us can give a really unambiguous answer ?!

The dictionary defines life as "the state of being alive" or "the period between birth and death" or in an even more philosophical sense "the union of soul and body".

None of these are however valid in a discussion on fetal "life".

Then we have the legal definitions. In India, where I live, for instance, the life of a fetus is dependent on its anticipated survival after delivery.
"Viability (of a fetus) is defined as the capacity of the fetus to lead a separate life after birth. A fetus attains viability after 210 days (7 months) of intra-uterine life. In law, a fetus delivered within this period is presumed NOT TO HAVE LIVED."

In other countries, this period may differ, since premature infants are now being salvaged at increasingly smaller birth weights and shorter in-utero periods.

So here is the dilemma. How should we view efforts at fetal surgery - as attempts to save an undefined "life", or merely as "experiments" to repair anomalies in a defective fetus ?

The guiding principle for doctors has always been

This last, then, is alone enough justification to further explore the uncharted seas of fetal cardiac surgery. From the moment of conception, the fetus would be considered a "patient". Certainly it seems justified to think so, since the heart "beats" and the lungs "breathe" even as early as the 10th week in the womb.

We doctors strive to lengthen a life when doing so is felt to be in the patient's "best interests"...

But we are still on shaky ground here. When so much is unknown about the outcome of fetal surgery, how can we be so sure that what we do will be in the patient's best interests ? Would it be better, if we just allow the pregnancy to continue to term under close supervision, and instead concentrate on improving our techniques to correct heart defects in the neonate after birth ?

This question can only be answered with time. When actual results of fetal intervention are available, they could be compared against the natural course of the heart defect without treatment. Only then can any "scientific" judgement be made about the superiority of one approach.

Everyone involved in this ground-breaking effort should keep this quotation in mind. Upon this pioneering lot falls the enormous burden of deciding between what is useful and necessary, as opposed to that which is harmful. May all assistance, divine and otherwise, be bestowed upon them to perform this task successfully !

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