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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.
 「生命の選別」という重い課題が突き付けられたと言えよう。放置することはできまい。

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.
 女性が双子以上の多胎児を妊娠した際、病気や異常がある胎児を選んで中絶する減胎手術が、これまでに36例行われていた。実施した長野・諏訪マタニティークリニックの根津八紘院長が公表した。

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.
 多胎妊娠は、不妊治療に伴って起きやすく、早産など母子の健康面でも危険性が高い。

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.
対策として、一部の胎児を薬で中絶し、胎児の数を減らして出産させるのが減胎手術だ。国内では根津院長が1986年に初めて実施した。

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.
 胎児の健康状態を調べる出生前診断技術の進歩が、問題の背景にある。妊娠中の超音波検査が普及し、胎児の異常を見つけやすくなった。4月には、ダウン症などの有無が血液検査でほぼ確実に分かる新型出生前診断も始まった。

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.
 出生前診断について、日本産科婦人科学会は6月、高齢妊娠など染色体異常が起きる可能性が高い場合を対象とし、カウンセリングの体制が整った施設で実施すべきだとする指針を決めた。
 ただ、指針を減胎手術にどう適用するかは定められていない。

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.
 厚生労働省の審議会は2000年、減胎手術は「原則として行うべきではない」としながら、母子の健康を守るために実施がやむを得ない場合もあり、「ルール化が必要」との報告をまとめた。

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.
 だが、ルール作りは容易ではない。様々な人生観や宗教観、生命倫理の問題が広がり、議論が収束する見通しが立たないからだ。

At present, each medical institution decides at its own discretion whether to conduct selective reduction surgery.
 減胎手術を実施するかどうかの判断は、個別の医療機関に委ねられているのが現状だ。

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.
 根津院長に減胎手術を受けた妊婦の中には、他の医療機関でこの手術について説明されず、全児を産むか、全児を中絶するか、判断を求められた人もいるという。妊婦にとって酷な選択だろう。

They should be provided with essential information to make an appropriate decision.
 妊婦側が適切な判断をするための情報提供が求められる。

It is also necessary to prevent multiple pregnancies.
 多胎妊娠の予防も重要だ。

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.
 複数の受精卵を子宮に戻す体外受精の普及で多胎が増え、産科婦人科学会は08年、移植する受精卵を原則として1個に制限した。

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.
 これにより、体外受精に伴うケースは減ったものの、排卵誘発剤による多胎妊娠はいまだに多い。出生前診断がさらに普及すれば、異常が見つかった胎児の減胎手術は今後も増えるだろう。

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.
 医療現場に判断を任せきりにしてはならない。国民全体で考えるべき時期に来ている。

(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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