Diligence of prenatal tests and their consequences for the health of the future child

Abstract

Performing prenatal tests and intrauterine treatment are closely related, because the lack of the former excludes the latter. It is also indirectly related to the termination of pregnancy by a planned caesarean section, when the fetus shows defects that require such a decision. In Poland prenatal surgeries are not a common practice, however, they are successfully performed in specialised centres and with guaranteed reimbursement. This makes them more and more commonly considered by patients. The success of the procedure in most diseases does not lead to the reversal of the defect, only to the inhibition of its development, which is still considered as a success. Children are born in a better condition and have a chance to survive or to live a better life than compared to when they were untreated. Operations of this kind are technically difficult and dangerous for a woman's health. As for the fetus, there is a risk of failure. As with every surgery, there are medical indications for them: fetal, positive factors on the mother's side and more or less strong contraindications. If the treatment has a formal status of an experiment, this should be reflected in the inclusion and exclusion criteria formulated in the protocol of the experiment, which is a document submitted to the bioethics committee giving its opinion on the project. The qualification for treatment should be based on the said criteria. The information provided prior to the withdrawal of consent should order the issues of the expected effectiveness of the treatment, the prognosis of the improvement of the child's health condition, but most of all - the health burden for the woman. Surgery does not constitute a therapeutic activity for a woman and it is only verified by fully voluntary consent  once the adequate information is provided. The surgery is an act of sacrifice on the part of the woman, so it cannot be required nor enforced, just like a caesarean section from the fetal indications. Any chance of success, however, is cancelled out by not detecting the defect during the proper period of pregnancy. Therefore, doctors performing prenatal examinations have a great moral responsibility for the further course of events. Imprudently performed diagnostics leads to false positive results and makes it impossible to take any remedial measures. With the current state of knowledge and sensitivity of the diagnostic equipment, such care may be required and evaluated according to objective criteria that can be arranged in a checklist. Subjective perceptiveness retains its importance, but certain deficiencies are in themselves evidence of culpable professional incompetence or deliberate concealment of information. The analysis of the cited compensation, disciplinary and prosecutorial cases leads to the conclusion that in many cases USG examinations, which are crucial for determination of the condition of the fetus, were carried out superficially and without the doctor's interest in a reliable result. Patients who were kept in the illusion that their children would be born healthy did not seek prenatal medical help. The children were born with more damage than they would have been treated at the right time. Some of them died right after the birth. These women, who were completely unaware of the situation, wrongly blame the obstetricians.. The judiciary recognises the harm resulting from the mother’s lack of information and a violation of the right to an informed decision, but refuses to accept an adequate causal link between the negligence of information and the prenatal uninformed impediment to the deterioration of the health of the born child and rejects the claim for compensation for the damage caused.