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Navigating the post-Dobbs landscape: ethical considerations from a perinatal perspective

Journal of Perinatology (2024)Cite this article

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Abstract

Restrictive abortion laws have impacts reaching far beyond the immediate sphere of reproductive health, with cascading effects on clinical and ethical aspects of neonatal care, as well as perinatal palliative care. These laws have the potential to alter how families and clinicians navigate prenatal and postnatal medical decisions after a complex fetal diagnosis is made. We present a hypothetical case to explore the nexus of abortion care and perinatal care of fetuses and infants with life-limiting conditions. We will highlight the potential impacts of limited abortion access on families anticipating the birth of these infants. We will also examine the legally and morally fraught gray zone of gestational viability where both abortion and resuscitation of live-born infants can potentially occur, per parental discretion. These scenarios are inexorably impacted by the rapidly changing legal landscape in the U.S., and highlight difficult ethical dilemmas which clinicians may increasingly need to navigate.

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Acknowledgements

The authors would like to thank the Children’s Hospital Neonatal Consortium and the Palliative Care and Ethics (PACE) Focus Group, for providing the original forum which brought together this author group.

Author information

Authors and Affiliations

  1. Department of Pediatrics, Division of Neonatology, Connecticut Children’s Medical Center, Hartford, CT, USA

    Alaina Pyle

  2. University of Connecticut School of Medicine, Farmington, CT, USA

    Alaina Pyle

  3. Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Shannon Y. Adams, Jessica T. Fry & Natalia Henner

  4. Department of Pediatrics, Ann & Robert H Lurie Children’s Hospital of Chicago, Chicago, IL, USA

    Shannon Y. Adams

  5. Division of Neonatal and Pulmonary Biology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

    DonnaMaria E. Cortezzo

  6. Division of Pain and Palliative Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

    DonnaMaria E. Cortezzo

  7. Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA

    DonnaMaria E. Cortezzo

  8. Department of Anesthesiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA

    DonnaMaria E. Cortezzo

  9. Division of Neonatology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA

    Jessica T. Fry & Natalia Henner

  10. Division of Palliative Care, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA

    Jessica T. Fry & Natalia Henner

  11. Department of Pediatrics, Michigan Medicine–University of Michigan Medical School, Ann Arbor, MI, USA

    Naomi Laventhal

  12. Department of Pediatrics, Pediatric Palliative Care Team, Children’s National Medical Center, Washington, DC, USA

    Matthew Lin

  13. Division of Neonatology, Nemours Children’s Hospital - Delaware, Wilmington, DE, USA

    Kevin Sullivan

  14. Department of Pediatrics, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA

    Kevin Sullivan

  15. University of Wisconsin School of Medicine and Public Health, Madison, WI, USA

    C. Lydia Wraight

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  1. Alaina Pyle
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Contributions

AP participated in manuscript conception, design, preparation, critical editing, and development of thetable. SYA, DEC, JTF, NH, ML, KS, CLW participated in manuscript conception, design, preparation,and critical editing. NL critically reviewed and edited the manuscript, provided additional expertise on neonatal bioethics. All authors reviewed and approved the final version of the manuscript.

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Correspondence to Alaina Pyle.

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Pyle, A., Adams, S.Y., Cortezzo, D.E. et al. Navigating the post-Dobbs landscape: ethical considerations from a perinatal perspective. J Perinatol (2024). https://doi.org/10.1038/s41372-024-01884-9

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