The ethics of over diagnosis in fetal medicine: A case for more prudent communication?

The widespread adoption of prenatal ultrasound has revolutionized fetal medicine, enabling earlier detection of anatomical abnormalities. However, this technological progress has given rise to a concerning phenomenon of overdiagnosis, particularly evident in conditions like antenatal hydronephrosis. This review explores the ethical implications of diagnosing and communicating fetal conditions with high rates of spontaneous resolution, using ANH as a paradigmatic example. Through the lenses of medical epistemology, principlist bioethics, and postmodern critiques of medical authority, we critically examine current communication practices and their impact on expectant parents. We argue that the threshold for disclosing certain prenatal findings should be reevaluated to balance the principles of parental autonomy and beneficence with the potential psychological harms of unnecessary medicalization. A threshold-based disclosure approach is herewith proposed wherein the communication strategies are calibrated to the severity and clinical significance of antenatal findings. This includes pre-testing counseling about the possibility of detecting variations with uncertain significance, using non-pathologizing language when discussing findings, and developing proportional follow-up protocols that minimize unnecessary medicalization while ensuring appropriate monitoring for clinically significant anomalies.