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Hastings Center Report

CASE STUDY: A Small-Town Heart

Abstract: Melanie presented at twenty weeks of gestation to an obstetrics clin­ic in a critical access hospital in rural Vermont. She was excited to undergo routine fetal ultrasonography, but her obstetrician gave her grave news: the ultrasound re­vealed hypoplastic left heart syndrome, a devastating congenital heart defect. Initially, Melanie agreed in general to pursue surgical care for her fetus—a three-stage process ­that has somewhat uncertain results and could only be done in tertiary care facilities far from her home in Vermont. A week later, while the maternal fetal medicine and pediatric cardiology units made ar­rangements with colleagues in Boston, Melanie began having second thoughts. An ethics meeting was called to dis­cuss conflicting clinician reactions to Melanie’s dilemma. Most of the clini­cians were stunned that the patient would change her mind. What advice should the ethics consultant offer the team about caring for Melanie?

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