Wrongful Birth Litigation, Clinical Practice Guidelines on Prenatal Screening, and Implications for Physicians, Patients and Disabled Canadians

摘要

Canadian clinicians must be aware of new standards of care resulting from national clinical practice guidelines, both to ensure best practice and to avoid malpractice litigation. Clinical practice guidelines can reduce successful malpractice actions through physician education and they may be used in court as evidence that the standard of care was met. The 2007 clinical practice guidelines on prenatal screening for fetal aneuploidy have expanded the potential for successful wrongful birth litigation and have set a new standard for family physicians, obstetricians, laboratory physicians, radiologists, geneticists, midwives, registered nurses, genetic counselors and ultrasound technicians. The clinical practice guidelines on prenatal screening were endorsed by the Society of Obstetricians and Gynaecologists of Canada and the Canadian College of Medical Geneticists. The guidelines include the recommendation that all pregnant women be offered prenatal screening, rather than just women aged 35 years or more, the age at which the risk of losing a fetus as a complication of an amniocentesis is equal to the risk of giving birth to a child with Down syndrome. This recommendation was in response to the observation that 56% of women who give birth to a child with Down syndrome are under 35 years of age. New sensitive and noninvasive screening strategies have made this recommendation possible. Recent clinical practice guidelines in the United Kingdom, Australia, New Zealand and the United States, have similarly recommended offering of screening for Down syndrome to all pregnant women. It is too early to evaluate the legal impact of such clinical practice guidelines in these jurisdictions.