Ethical dilemmas in voluntary termination of pregnancy with severe congenital anomalies

• Screening during antenatal care enables informed decision-making in congenital anomaly (CA). • Routine screening identifies CA by 22 weeks; termination is advised by 24 weeks. • Ethical medical decisions must prioritize patient welfare and autonomy. • Prenatal diagnosis involves complex ethical decision-making and support processes. • Ethical decision-making in CA could use Jonsen et al. approach. Congenital anomalies (CA) are structural or functional disorders from genetic defects of the fetus occurring in the uterine. However, screening for congenital disabilities to establish a prenatal diagnosis raises many moral considerations and ethical dilemmas in the field of medicine. A detected severe CA consequence to termination of pregnancy in the management option, making it an undoubtful ethical dilemma. A literature search was carried out on Indonesian laws, ethical codes, and regulations related to congenital anomalies, utilizing resources such as the Indonesian Medical Association (Ikatan Dokter Indonesia) and the conference proceedings of the Royal College of Obstetricians and Gynecologists (RCOG). An extensive literature search was also utilized from PubMed, Clinical Key, and Elsevier Science journals with specific keywords. Ethical dilemmas often arise in the context of prenatal diagnosis, which involves a complex process across five distinct stages: disclosure of information to parents, establishing indications for examinations, providing information about a diagnosis, providing psychological and social support, and making diagnostic decisions. The framework proposed by Jonsen, Siegler, and Winslade can be applied to ethical decision-making in the present case. The choice to terminate a pregnancy due to genetic anomalies or congenital disabilities must comply with the legal bases. The principles of autonomy of each patient and the results of the doctor's decisions have been carefully considered, and the obstetrician must make every effort to respect and protect the dignity of human life.