G197 MANAGEMENT OF CONDITIONS DIAGNOSED ANTENATALLY WITH A POOR PROGNOSIS: PRE- AND POSTNATAL ETHICAL AND LEGAL DIFFICULTIES

P. de Halpert, B. Yuksel. Barnet and Chase Farm Hospitals NHS Trust, Department of Paediatrics, The Ridgeway, Enfield, London EN2 8JL

Introduction: Current standards of antenatal investigation allow a large range of foetal conditions to be diagnosed. Coupled with genetic testing from amniocentesis or chorionic villous sampling, accurate diagnoses and prognoses can be given to parents from an early gestation. We would like to present two children and their families who were diagnosed antenatally with serious congenital abnormalities.

Objective: To highlight the ethical and emotional problems faced by these families and by medical staff, and assess ways of helping parents make informed choices.

Methods: The cases of two children, who had antenatally diagnosed congenital abnormalities, and were admitted to the special care baby unit, are reviewed.

Patients: The first infant was antenatally diagnosed with holoprosencephaly and cleft lip and palate. His mother had had a previous pregnancy terminated for the same condition. She decided, after counselling, that she could not terminate this pregnancy. He was born in good condition at term and his mother, after initially refusing resuscitation or medical intervention, then wanted full medical intervention. However, she found it emotionally difficult to cope with him. The second infant was antenatally diagnosed with Roberts syndrome. The parents decided against termination for religious reasons. She was born in good condition and survived; however, the parents did not wish her to have any medical intervention including resuscitation.

Result: Two families were offered termination of pregnancy for congenital abnormalities, they both refused. One family wanted full intervention for the child, the other family wanted none. Both, understandably, found it emotionally difficult.

Conclusion: These cases illustrate the different ethical and emotional difficulties for the parents. Methods of supporting families faced with these difficult choices must be ensured to be in place.

G198 MEDICAL MANSLAUGHTER OR SYSTEMS FAILURE

A. C. Elias-Jones. …