C-section for organ donation.

KIE: A woman carrying a fetus with anencephaly requests a cesarean delivery when signs of fetal distress are detected. Her intention is to donate the organs for transplantation if the child is born alive. Commentators are asked if the woman's physician should accede to her request, and if the risks to the patient of a cesarean section are justified in this case. Berkowitz and Newman argue against surgical intervention as not medically indicated for mother or fetus, and as posing greater risks than offering benefits. Mathieu argues that while the chances are slight of obtaining transplantable organs in this case, the physician is not justified in overriding a competent patient's request for cesarean delivery.^ieng

A committee consults: the care of an anencephalic infant.

KIE: A hospital ethics committee's deliberations concerning the care of an anencephalic newborn are summarized. Because the defect was irreversible and rapidly lethal, resuscitation and mechanical ventilation were deemed not medically or legally required. The issue of providing fluids and nutrition was complicated: while tube feeding was possible, the infant was beginning to aspirate glucose water, in itself a possible cause of death. Intravenous (IV) feeding might be painful, but could an infant without higher brain structures experience pain? The committee also considered the emotional impact of withholding such treatment on the nurses and family. In the end, no consensus was reached on the issue of withholding fluids and nutrition. The author concludes that the priority concerns, when a decision is made to withhold support from a terminally ill infant, are to avoid pain to the infant and to provide emotional support to the family and staff.^ieng