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2013年8月15日 (木)

減胎手術 生命倫理に関する議論深めよ

The Yomiuri Shimbun August 15, 2013
Multifetal reduction surgery problems must be addressed
減胎手術 生命倫理に関する議論深めよ(8月14日付・読売社説)

The dispute over multifetal reduction surgery at a maternity clinic in Nagano Prefecture poses a fundamental question regarding the screening of unborn babies. The controversy must not be left unaddressed.

Last Thursday, Yahiro Netsu, director of Suwa Maternity Clinic in Shimosuwa, revealed that he had performed 36 operations called multifetal pregnancy reduction. The surgery was aimed at aborting one or more fetuses found to have diseases and abnormalities in multifetal pregnancies.

A multiple pregnancy is liable to occur concomitantly with fertility treatment. These kinds of pregnancies increase the risk of health problems for mothers and babies, including the possibility of premature births.

Selective reduction surgery is the practice of aborting one or more fetuses through the use of a chemical substance, thereby reducing the number of fetuses in a multifetal pregnancy. Japan’s first selective reduction operation was performed by Netsu in 1986.

The key factor behind the controversy is the technological advancement in prenatal diagnosis used to examine the health of a fetus. The spread of the ultrasonic diagnostic method has made it easier to discover abnormalities. In April, the use of a new prenatal diagnostic method was launched, making it possible, with a good measure of certainty, to determine whether an unborn baby has a disorder such as Down syndrome through a blood test.

In June, the Japan Society of Obstetrics and Gynecology laid down a set of guidelines on the use of prenatal diagnosis. The guiding principles require diagnoses to be limited to cases in which chromosomal aberrations are likely to occur, including late-in-life pregnancy. They also state that such a diagnosis should be carried out only at facilities that can provide adequate counseling for pregnant women. However, the guidelines do not state how these principles should be applied in multifetal pregnancy reduction surgery.

In 2000, an advisory panel to the Health, Labor and Welfare Ministry compiled a report stating that selective reduction operations should not be performed “as a general rule.” At the same time, however, the report added that there were some cases in which such an operation must be performed to protect the health of pregnant women and their babies. “It is necessary to work out a set of rules,” it said.

Wide range of issues

However, it will not be easy to formulate such rules. It is not known whether a consensus can be reached through discussions on the pros and cons of performing selective reduction surgery. This is because the controversy over multifetal pregnancy reduction entails a wide range of issues, including an individual’s view of life, fundamental standpoints peculiar to different religions and ethics.

At present, each medical institution decides at its own discretion whether to conduct selective reduction surgery.

Before undergoing a selective reduction operation at Netsu’s clinic, one woman expecting a multiple birth reportedly visited another medical institution where she was urged to decide whether to give birth to all the babies or abort them. She was not given an explanation about what a multifetal reduction operation entailed. For pregnant women, deciding whether to undergo such an operation is extremely difficult.

They should be provided with essential information to make an appropriate decision.

It is also necessary to prevent multiple pregnancies.

In 2008, the obstetrics and gynecology society said only one fertilized egg should be placed in the uterus of a woman. This was in response to an increasing number of multiple pregnancies involving more than one fertilized egg being placed in the uterus during in vitro fertilization.

The society’s statement resulted in a decrease in the number of multiple pregnancies through in vitro fertilization. However, there still are a number of multiple pregnancies due to ovulation-inducing drugs. If prenatal diagnosis becomes more common, it will likely lead to a rise in the number of selective reduction operations in the future.

Making a decision about whether to perform such an operation should never be left to the medical profession, or medical institutions for that matter. It is time for the public as a whole to consider the problem of multifetal pregnancy reduction.

(From The Yomiuri Shimbun, Aug. 14, 2013)
(2013年8月14日01時56分  読売新聞)


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