My wife was told that her fetus in the 16th week of pregnancy has Trisomy 18. The Ob/Gyn is recommending an elective abortion because the condition of Trisomy 18 is not compatible with life. What is your opinion?
Trisomy 18, also known as Edwards’ syndrome, is a chromosomal abnormality associated with severe developmental abnormalities affecting multiple organs. Because of those anomalies the majority of the fetuses do not survive to term or die within their first months of life. However, 5% to 10% of infants with trisomy 18, most of whom possess an extra copy of chromosome 18 only in few cells of the body, live longer than one year and survive to the teenage years in spite of serious medical and development problems.
Elective abortion or early induction of labor constitutes the currently most common medical recommendation provided to a pregnant woman carrying a fetus with trisomy 18, on the ground that this chromosomal abnormality is a lethal and incompatible with life. According to the Catechism of the Catholic Church it is gravely immoral to support a couple’s decision to end the pregnancy through an early induction of labor when the developmental stage of the fetus is incompatible with life outside the uterus and when neither the mother’s health nor the fetal life are in danger [1]. In those circumstances, the early induction of labor configures an act of elective abortion that is morally unacceptable. That moral stance has been confirmed by the US Conference of Bishops in the Ethics and Directive for Catholic Health Care Services. In particular, paragraph 49 of that document states “For a proportionate reason, labor may be induced after the fetus is viable”.[2] Since the threshold for fetal survival in the US has been set up at 24 weeks of gestation, the early delivery of a 16 week fetus is an act of elective abortion that is utterly immoral. Furthermore, the scenario depicted in the question reveals the incorrectness of the provided medical counseling that failed to take into consideration both the improvement of survival of those infants with trisomy 13 and 18 submitted to multiple surgeries [3] as well the reports of the rewarding experience of families living with a child with trisomy 18.[4] It is highly advisable that obstetricians, genetic counselors and ethicist abandon the ‘lethal language’ leading to ‘lethal decisions’ and be more respectful of the parents’ decisions and preferences of not terminating the life of a baby with trisomy 18.[5]
[1] Catechism of the Catholic Church, nn 2270-1.
[2] United States Conference of Catholic Bishops, Ethical and Religious Directives for Catholic Health Care Services, 2009: n 49.
[3] Nelson KE, Hexem KR, Fudtner C. Inpatient Hospital Care of Children with Trisomy 13 and Trisomy 18 in the United States, Pediatrics, 2012:129(5):869-76. doi: 10.1542/peds.2011-2139. Epub 2012 Apr 9. http://www.ncbi.nlm.nih.gov/pubmed/22492767 (Accessed on August 9, 2013).
[4] Janvier A, Farlow B., Wilfond B, The Experience of Families with Children
with Trisomy 13 and 18 in Social Networks Pediatrics 2012 Aug;130(2):293-8. doi: 10.1542/peds.2012-0151. Epub 2012 Jul 23.
http://www.ncbi.nlm.nih.gov/pubmed/22826570 (Accessed on August 12, 2013).
[5] Koogler TK, Wilfond BS, Friedman Ross L. Lethal Language, Lethal Decisions Hasting Center Report. 2003:33, 37-41.