Research

University of Illinois at Chicago College of Medicine

Ethics in Clerkships

Case for Discussion : Disclosing a Mistake
Nancy Shaw was an 18-year-old in the seventeenth week of her first pregnancy when she was examined by ultrasound at health department clinic. That ultrasound revealed that her fetus had extreme and symmetrical shortening of the limbs. The clinic referred Ms. Shaw to the prenatal diagnosis center of a public hospital. There, Ms. Shaw discussed possible causes of the abnormalities with a genetic counselor. Following that discussion, Ms. Shaw decided to terminate the pregnancy. At that time, amniotic fluid was drawn for analysis. A medical student, John Dutchman, who was present with the attending physician, Dr. Lowland, before and after the termination was surprised to hear the attending physician tell Ms. Shaw that the fetus had been female. Mr. Dutchman had not realized that a woman undergoing an abortion would want this kind of information. The attending physician told him that Ms. Shaw had specifically asked for this information because she wanted to name the baby and have a short memorial service for her, as if she had died naturally. Ms. Shaw chose the name Elizabeth for her child.
Subsequent laboratory analysis showed that the fetal deformities were due to Roberts syndrome. That analysis also showed the fetus to have a karyotype of 46, XY, indicating that the fetus was male. Mr. Dutchman asked the physician whether he should advise Ms. Shaw that an error had been made in announcing the sex of the fetus to her. Dr. Lowland said that there was no medical benefit that would occur if Ms. Shaw were told this information. Revealing the information, he said, would not change the risk of the condition in future pregnancies or do anything to change the sense of loss already experienced by Ms. Shaw. He argued, very strongly, that disclosing this information could disrupt the woman’s grief resolution, by opening the tragedy anew. He did not want Ms. Shaw, in any case, having doubts that other errors might have occurred in managing her pregnancy or offering counsel about abortion.
Mr. Dutchman did not express his thoughts aloud, but he was unconvinced by these arguments. He wondered whether he should do something himself, either contact Ms. Shaw directly or continue to confront Dr. Lowland about the matter. (Modified from An Ethics Casebook for Genetic Counselors, 1994.)