A Small-Town Heart

Tim Lahey, Jennifer L. Herbst, Marielle S. Gross, Brandi Braud Scully

Research output: Contribution to journalArticlepeer-review


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.

Original languageEnglish (US)
Pages (from-to)4-7
Number of pages4
JournalThe Hastings Center report
Issue number6
StatePublished - Nov 1 2020
Externally publishedYes


  • children and health care
  • doctor-patient relationship
  • rural bioethics

ASJC Scopus subject areas

  • Health(social science)
  • Issues, ethics and legal aspects
  • Philosophy
  • Health Policy


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