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Table 1 Case Chart

From: Shall parent / patient wishes be fulfilled in any case? A series of 32 ethics consultations: from reproductive medicine to neonatology

Fields No Ethical focus of presented problem(s) Wishes of patient / parents Wishes supported
Reproductive Medicine R1 Infertile husband, diagnosed with cystic fibrosis, wishing treatment with assisted reproduction ICSI despite uncertain life expectancy of the father-to-be Yes
R2 Infertile multimorbid husband with severe Diabetes mellitus Type 2 ICSI despite uncertain life expectancy of the father-to-be Yes
R3 After termination of pregnancy of healthy twin pregnancy after ICSI using donated semen Wish for another treatment with ICSI No
R4 Infertile husband and failed testicular biopsy Sperm donation of husband’s father No by EC changed into Yes by head physician.
R5 Infertile husband with osteogenesis imperfecta ICSI despite possible risk of giving on the disease Yes
R6 Multimorbid wife with kidney failure and extremely rare blood type ICSI despite possible deadly complications during pregnancy and delivery Yes by EC changed into No by head physician.
R7 Wife with multiple sclerosis and unfulfilled desire to have children ICSI despite progressive disabling sickness No
R8 Wife with several miscarriages after ICSI and borderline personality disorder which worsened after miscarriage causing conflict with the team Repetition of ICSI Yes
Obstetrics S1 Twin pregnancy with impending delivery, need for lung-maturation-treatment after reproductive treatment abroad Refusal of lung maturation; only “healthy” children to survive No
S2 Request for abortion in the 16th week because of gastroschisis Abortion after 12th week in case of a treatable disease No
S3 Triplet pregnancy after ICSI and risk for preeclampsia Selective feticide Yes
S4 PPROM in 21st week, lack of compliance (fundamental evangelical church) Refusal of treatment insisting on God’s direct support No
S5 Healthy twin pregnancy after ICSI and denial of selective feticide Abortion of both unborn children No
S6 Diagnosis of trisomy 18 in 25th week Comfort care and refusal of life-sustaining measurements Yes
S7 Request for termination of pregnancy in the 14th week because of minor hand malformation, no impact on child’s QoL Termination of pregnancy after 12th week in case of minor malformation No
S8 Incompetent patient (low IQ), life-threatening pregnancy Patient’s father requests abortion Yes
Patient’s father requests for sterilisation No
S9 Request for termination of pregnancy in the 21st week by the 15yo pregnant woman Abortion after 12th week No
S10 Request for termination of pregnancy in 22nd week because of cleft lip and palate Abortion after 12th week in case of treatable disease No
S11.1 Unborn child with a complex of multiple diseases not compatible with life in the 26th week of pregnancy Carrying out pregnancy but no medical intervention Yes
S11.2 Unborn child with a complex of multiple diseases not compatible with life in the 33rd week of pregnancy Giving birth to a living child by caesarean section Yes
S12 Request for abortion in 22nd week because of distal forearm malformation Abortion after 12th week in case of treatable disease No
S13 Single mother with a strict Muslim background requests termination of pregnancy in the 22nd week Abortion after 12th week in case of psychosocial distress Yes
S14 Premature rupture of membranes in 20th week of pregnancy Request for determined advice for further procedure No
Neonatology N1 Limitation vs. intensification of treatment in preterm new-born with brain haemorrhage Drug-addicted mother requests maximum treatment No
N2 Parents of full term new-born with asphyxia request EC to discuss further treatment limitation Treatment limitation of life-sustaining measurements incl. Fluid supply No
N3 Full term new-born with apallic syndrome after intracranial haemorrhage. Planning of further steps Father requested treatment limitation incl. food & fluid supply referring to outdated guideline No
N4 Full term new-born with VACTERL association. Planning of further steps Wish for “perfect child”, vote in favour of surgery No
N5 Treatment limitation in preterm-born infant with extended brain damage Limitation of food supply No
N6 Preterm new-born with trisomy 18 in mosaic. Planning of further steps Parents (Muslims) designate the child “a gift from God” and wish maximum treatment No
N7 Treatment limitation in case of severe asphyxia + maternal postpartum death Widowed father initially requested DNR No
Neurosurgery NC1 Pregnant women with intracerebral bleeding in 21st week of pregnancy and unborn child with multiple diseases. Termination vs. continuation of pregnancy regarding prognosis of both mother and child Continuation of pregnancy Yes
Family Planning F1 Patient with severe depression with unfulfilled desire to have children after having two abortions because of her mental condition Wish for removal of IUD (Yes)