Ethical aspects of diagnosis and interventions for children with Fetal Alcohol Spectrum Disorder (FASD) and their families

BMC Medical Ethics - Tập 19 - Trang 1-7 - 2018
Gert Helgesson1, Göran Bertilsson2, Helena Domeij2, Gunilla Fahlström2, Emelie Heintz2,3, Anders Hjern4, Christina Nehlin Gordh5, Viviann Nordin6, Jenny Rangmar7, Ann-Margret Rydell8, Viveka Sundelin Wahlsten9, Monica Hultcrantz10,2
1Stockholm Centre for Healthcare Ethics (CHE), Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
2Swedish Agency for Health Technology Assessment and Assessment of Social Services (SBU), Stockholm, Sweden
3Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
4Clinical Epidemiology, Department of Medicine, Karolinska Institutet and Center for Health Equity Studies, Stockholm, Sweden
5Department of Neuroscience Psychiatry, Uppsala University, Uppsala, Sweden
6Center of Neurodevelopmental Disorders, Karolinska Institutet (KIND), Stockholm, Sweden
7Department of Psychology, University of Gothenburg, Gothenburg, Sweden
8Department of Psychology, Uppsala University, Uppsala, Sweden
9Department of Neuroscience, Child and Adolescent Psychiatry, Uppsala University, Uppsala, Sweden
10Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden

Tóm tắt

Fetal alcohol spectrum disorders (FASD) is an umbrella term covering several conditions for which alcohol consumption during pregnancy is taken to play a causal role. The benefit of individuals being identified with a condition within FASD remains controversial. The objective of the present study was to identify ethical aspects and consequences of diagnostics, interventions, and family support in relation to FASD. Ethical aspects relating to diagnostics, interventions, and family support regarding FASD were compiled and discussed, drawing on a series of discussions with experts in the field, published literature, and medical ethicists. Several advantages and disadvantages in regards of obtaining a diagnosis or description of the condition were identified. For instance, it provides an explanation and potential preparedness for not yet encountered difficulties, which may play an essential role in acquiring much needed help and support from health care, school, and the social services. There are no interventions specifically evaluated for FASD conditions, but training programs and family support for conditions with symptoms overlapping with FASD, e.g. ADHD, autism, and intellectual disability, are likely to be relevant. Stigmatization, blame, and guilt are potential downsides. There might also be unfortunate prioritization if individuals with equal needs are treated differently depending on whether or not they meet the criteria for a specific condition. The value for the concerned individuals of obtaining a FASD-related description of their condition – for instance, in terms of wellbeing – is not established. Nor is it established that allocating resources based on whether individuals fulfil FASD-related criteria is justified, compared to allocations directed to the most prominent specific needs.

Tài liệu tham khảo

Hoyme HE, Kalberg WO, Elliott AJ, Blankenship J, Buckley D, Marais AS, et al. Updated clinical guidelines for diagnosing Fetal Alcohol Spectrum Disorders. Pediatrics. 2016;138(2):e20154256. Domeij H, Rangmar J, Sundelin Wahlsten V, Bertilsson G, Fahlström G, Heintz E, et al. Psychological, physical and social functioning among individuals fulfilling the criteria for the entities within the Fetal Alcohol Spectrum Disorders. A systematic review and meta-analysis. (Submitted manuscript). Stade B, Beyene J, Buller K, Ross S, Patterson K, Stevens B, et al. Feeling different: the experience of living with fetal alcohol spectrum disorder. J Popul Ther Clin Pharmacol. 2011;18:e475–85. Salmon JV, Buetow SA. An exploration of the experiences and perspectives of new Zealanders with fetal alcohol spectrum disorder. J Popul Ther Clin Pharmacol. 2012;19:e41–50. Mukherjee R, Wray E, Commers M, Hollins S, Curfs L. The impact of raising a child with FASD upon carers: findings from a mixed methodology study in the UK. Adoption & Fostering. 2013;37(1):43–56. Sanders JL, Buck GA. Long journey: biological and non-biological parents’ experiences raising children with FASD. J Popul Ther Clin Pharmacol. 2010;17(2):e308–22. Michaud D, Temple V. The complexities of caring for individuals with fetal alcohol Spectrum disorder: the perspective of mothers. JODD. 2013;19(3):94–101. Swedish Agency for Health Technology Assessment and Assessment of Social Services (SBU). Fetalt alkoholsyndrom (FAS) och Fetala alkoholspektrumstörningar (FASD) – Tillstånd och insatser: En systematisk översikt och utvärdering ur ett socialt, medicinskt, ekonomiskt och etiskt perspektiv. Stockholm, 2016. SBU-report no 258. ISBN 978-91-88437-00-6. Kagan S. Normative ethics. Boulder, CO: Westview Press; 1998. Holm S, Irving L. Empirical Research in Bioethics: Report for the European Commission. In: Engaging the World: The Use of Empirical Research in Bioethics and the Regulation of Biotechnology. Amsterdam: IOS Press; 2004. p. 131–56. Musschenga AW. Empirical ethics, context-sensitivity, and contextualism. J Med. Philosophy. 2005;30:467–90. Heintz E, Lintamo L, Hultcrantz M, Jacobson S, Levi R, Munthe C, et al. Framework for systematic identification of ethical aspects of healthcare technologies: the SBU approach. Int J Technol Assess Health Care. 2015;31(3):124–30. Salmon J. Fetal alcohol spectrum disorder: New Zealand birth mothers’ experiences. Can J Clin Pharmacol. 2008;15:e191–213. Chamberlain K, Reid N, Warner J, Shelton D, Dawe SA. Qualitative evaluation of caregivers’ experiences, understanding and outcomes following diagnosis of FASD. Res Dev Disabil. 2017;63:99–106. Watson SL, Hayes SA, Coons KD, Radford-Paz E. Autism spectrum disorder and fetal alcohol spectrum disorder. Part II: a qualitative comparison of parenting stress. J Intellect Develop Disabil. 2013;38:105–13. Johnston S, Boyle JS. Northern British Columbian aboriginal mothers: raising adolescents with fetal alcohol spectrum disorder. J Transcult Nurs. 2013;24:60–7. Price KJ, Miskelly KJ. Why ask why? Logical fallacies in the diagnosis of fetal alcohol Spectrum disorder. Ethics and Behavior. 2015;25:418–26. Ryan S, Ferguson DL. On, yet under, the radar: students with fetal alcohol syndrome disorder. Except Child. 2006;72:363–79. Chandler A, Whittaker A, Cunningham-Burley S, Williams N, McGorm K, Mathews G. Substance, structure and stigma: parents in the UK accounting for opioid substitution therapy during the antenatal and postnatal periods. Int J Drug Policy. 2013;24:e35–42. Islam MS, Scott J, Minichello V. A Qualitative exploration of parental experiences of stigma while living with HIV in Bangladesh. AIDS Care. 2016;28(2):247–9. Juth N. Genetic information – values and rights: the morality of presymptomatic genetic testing. Saarbrücken: Lambert Academikc Publishing; 2012. Swedish Agency for Health Technology Assessment and Assessment of Social Services (SBU). ADHD – Diagnostik och behandling, vårdens organisation och patientens delaktighet. En systematisk litteraturöversikt. Stockholm, 2013. SBU-report no 217. ISBN 91-85413-58-4. The Swedish National Board of Health and Welfare (Socialstyrelsen). http://www.socialstyrelsen.se/missbrukochberoende/missbrukundergraviditeten. Accessed 24 Mar 2017. Australian Government. National Health and Medical Research Council. Australian guidelines to reduce health risks from drinking. Alcohol. 2009; https://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/ds10-alcohol.pdf. Irish Government. Department of Health. https://www.health-ni.gov.uk/news/new-alcohol-guidelines-launched. Accessed 24 Mar 2017. May PA, Tabachnick BG, Gossage JP, Kalberg WO, Marais AS, Robinson LK, et al. Maternal factors predicting cognitive and behavioral characteristics of children with fetal alcohol spectrum disorders. J Dev Behav Pediatr. 2013;34:314–25. Miller AR. Diagnostic nomenclature for foetal alcohol spectrum disorders: the continuing challenge of causality. Child Care Health Dev. 2013;39:810–5. Todorow M, Paris K, Fantus E. Ethical considerations when communicating a diagnosis of a fetal alcohol spectrum disorder to a child. J Popul Ther Clin Pharmacol. 2012;19:e361–8. Meurk C, Lucke J, Hall WA. Bio-social and ethical framework for understanding fetal alcohol spectrum disorders. Neuroethics. 2014;7:337–44. Lowe PK, Lee EJ. Advocating alcohol abstinence to pregnant women: some observations about british policy. Health, Risk and Society. 2010;35:301–11.