減胎手術
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1 manolo 2013-08-21 19:35:47 [画像] [PC]

出典：　読売新聞（社説「減胎手術　生命倫理に関する議論深めよ」）、8/14/2013

1-1.　「生命の選別」という重い課題が突き付けられたといえよう。放置することはできない。女性が双子以上の多胎児を妊娠した際、病気や異常がある胎児を選んで中絶する減胎手術が、これまでに36例行われていた。実施した長野・諏訪マタニティークリニックの根津八紘院長が公表した。

1-2.　多胎妊娠は、不妊治療に伴って起きやすく、早産など母子の健康面でも危険性が高い。対策として、一部の胎児を薬で中絶し、胎児の数を減らして出産させるのが減胎手術だ。国内では根津院長が1986年に初めて実施した。

1-3.　胎児の健康状態を調べる出生前診断技術の進歩が、問題の背景にある。妊娠中の超音波検査が普及し、胎児の異常を見つけやすくなった。4月には、ダウン症などの有無が血液検査でほぼ確実にわかる新型出生前診断も始まった。

1-4.　出生前診断について、日本産科婦人科学会は6月、高齢妊娠など染色体異常が起きる可能性が高い場合を対象とし、カウンセリングの体制が整った施設で実施すべきだとする指針を決めた。ただ、指針を減胎手術のどう適用するかは定められていない。

1-5.　厚生労働省の審議会は2000年、減胎手術は「原則として行うべきでない」としながら、母子の健康を守るためにやむを得ない場合もあり、「ルール化が必要」との報告をまとめた。だが、ルール作りは容易ではない。様々な人生観や宗教観、生命倫理の問題が広がり、議論が収束する見通しが立たないからだ。
2 manolo 2013-08-21 19:40:45 [PC]

1-6.　減胎手術を実施するかどうかの判断は、個別の医療が機関に委ねられているのが現状だ。根津院長に減胎手術を受けた妊婦の中には、他の医療機関でこの手術について説明されず、全児を産むか、全児を中絶するか、判断を求められた人もいるという。妊婦にとって酷な選択だろう。妊婦側が適切な判断をするための情報提供が求められる。

1-7.　多胎妊娠の予防も重要だ。複数の受精卵を子宮に戻す体外受精の普及で多胎が増え、産科婦人科学会は08年、移植する受精卵を原則として１個に制限した。これにより、体が受精に伴うケースは減ったものの、排卵誘発剤による多胎妊娠はいまだに多い。出生前診断がさらに普及すれば、異常が見つかった胎児の減胎手術は今後も増えるだろう。

1-8.　医療現場に判断を任せきりにしてはならない。国民全体で考えるべき時期に来ている。
3 manolo 2013-08-21 20:04:02 [PC]

出典：　The Japan News（Editorial: "Multifetal reduction surgery problems must be addressed"）、August 15,2013、p.13

2-1. The dispute over multifetal reduction surgery at a maternity clinic in Nagano Prefecture poses a fundamental question regarding the screening of unborn babies. The controversy must not be left unaddressed. Last Thursday, Yahiro Netsu, dirctor of Suwa Maternity Clinic in Shimosuwa, revealed that he had performed 36 operations called multifetal pregrancy reduction. The surgery was aimed at aborting one or more fetuses found to have diseases in multifetal pregnancies.

2-2. A multifetal pregrancy is liable to occur concomitantly with fertility treatment. These kinds of pregnancies increase the risk of health problems for mothers and babies, including the possibility of premature births. Selective reduction surgery is the practice of aborting one or more fetuses through the use of a chemical substance, thereby reducing the number of fetuses in a multiple pregnancy. Japan's first selective reduction operation was performed by Netsu in 1986.

2-3. The key factor behind the controversy is the technological advancement in prenatal diagnosis used to examine the health of a fetus. The spread of the ultrasonic diagnostic meathod has made it easy to discover abnormalities. In April the use of a new prenatal diagnostic method was launched, making it possible, with a good measure of certainty, to determine whether an unborn baby has a disorder such a Down syndrome through a blood test.

2-4. In June, the Japan Society of Obsterics and Gynecology laid down a set of guidelines on the use of prenatal disgnosis. The guiding principles require diagnoses to be limited to case in which chromosomal aberrations are likely to occur, including late-in-life pregnancy. They also state that such a diagnosis should be carried out only at facilities that can provide adequate counseling for pregnant women. However, the guidlines do not state how these principles should be applied in multifetal pregnancy reduction surgery.

2-5. In 2000, an advisory panel to the Health, Labor and Welfare Ministry compiled a report stating that selective reduction operations should not be performed "as a general rule." At the same time, however, the report added that there were some cases in which such an operation must be performed to protect the health of pregnant women and their babies. "It is necessary to work out a set of rules," it said. However, it will not be easy to forumlate such rules. It is not known whether a consensus can be reached through discussions on the pros and cons of performing selective reduction surgery. This is because the controversy over multifetal pregnancy reduction entails a wide range of issues, including an individual's view of life, fundamental standpoints peculiar to different relogions and ethics.
4 manolo 2013-08-21 20:36:32 [PC]

（減胎手術続き）

2-6. At present, each medical institution decides at tis own discretion whether to conduct selective reduction surgery. Before undergoing a selective reduction at Netsu's clinic, one woman epecting a multiple birth reported visited another medical institution where she was urged to decede whether to give brith to all the babies or abort them. She was not given an eplanation about what a multifetal reduction operation entailed. For pregnant women, deciding whether to undergo such an operation is extremely difficult. They should be provided with essential information to make an appropriate decision.

2-7. It is also necessary to prevent multiple pregnancies. In 2008, the obsterics and gynecology society said only one fertilized egg should be placed in the uterus of a woman. This was in response to an increasing number of multiple pregnancies involving more than one fertilized egg being placed in the uterus during in vitro fertilization. The society's statement resulted in a decrease in the number of multiple pregnancies through in vitor fertilization. However, there still are a number of multiple pregnancies due to ovulation-inducing drugs. If prenatal diagnosis becomes more common, it will likely lead to a rise in the number of selective reduction oeprations in the future.

2-8. Making a decision about whether to perform such an operation should never be left to the medical profession, or medial institutions for that matter. It is time for the public as a whole to consider the problem of multifetal pregnancy reduction. (From The Yomiuri SHimbun, Aug 14, 2013)
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