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Keep your Keepsakes, for Pete’s SakeHarry H. HoldorfI tell my students that I am always looking out for their best interests. During our “Introduction to Ultrasound” class, we review and dissect the phenomenon known as Keepsake, or Boutique, ultrasounds. I am very straight with them. I start with the phrase, “always keep your friends close and your enemies closer.” I say that because in all practicality, these keepsake services probably won’t go away, and that it might be best to consider making it a better service by working for them. Why? Well, if a sonographer becomes registered in Ob/Gyn and puts in the clinical experience to become proficient in Obstetrics, then it might not be a bad idea to own this job opportunity. But, be wary… might taking a job at a boutique ultrasound serviced be akin to career suicide? Perhaps; but a job is a job, right?Obstetric ultrasound is a well-recognized prenatal test used to visualize and determine the condition of a pregnant woman and her fetus. Apart from the clinical application, some businesses are promoting the use of fetal ultrasound machines for nonmedical reasons. These “Keepsake” procedures are defined as using ultrasound to view a fetus, take images of the fetus, and or determine the sex of a fetus without a medical indication.Notwithstanding the guidelines and warnings regarding ultrasound safety issued by governments and professional bodies, the absence of scientifically proven physical harm to fetuses from these procedures has provided these businesses with grounds for rapid expansion.As nonmedical fetal ultrasound has aroused public attention, the ethical issues that come into play with this topic are essential:The precautionary principleTheories of consequentialism and impartialityDuty-based theoryRights-based theoryThe precautionary principle states that if an action has suspected risk of causing harm to the public, in the absence of scientific consensus that the action is not harmful, the burden of proof that it is NOT harmful falls on those taking an action.Consequentialism is the view that morality is all about producing the right kinds of overall consequences (everything the action brings about, including the action itself).Duty-based theory ethics are concerned with what people do, not with the consequences of their actions.The concept of rights-based theory is that there are some rights, both positive and negative, that all humans have based only on the fact that they are human.Hence, obstetric ultrasound practice is ethically justifiable only if the indication for its use is based on medical evidence. Nonmedical fetal ultrasound can be considered ethically unjustifiable. An increasing number of businesses are using ultrasound scanners to provide expectant parents with souvenir pictures and videos of their fetuses without any medical purpose. What are the negative effects? Well, another saying comes to mind. Ever hear “there’s no such thing as a free lunch?” While in capable hands and with guidelines in place, ultrasound can be relatively safe. But, no one really knows what harm can occur to a fetus if they are exposed to excessive and or unnecessary Ultrasonic energy. So, why chance it? Medical Tests are recommended and or ordered with an understanding that there is RISK vs. BENEFIT for any medical test. Another negative effect is that this service can create legal and regulatory problems both for operators of the businesses and for the manufacturers and distributors that sell them their equipment. There is risky business taking pictures of unborn babies when there is no medical need to do so, That’s the word from the Food and Drug Administration (FDA), which is concerned about companies trying to turn an important medical procedure into a prenatal portrait tool.The commercial ultrasound services appeal to expecting parents who hope to create special memories. The best memory to create, however, might be giving birth to a healthy baby. Ultrasounds have become so routine that people forget its real purpose. Many expectant parents look forward to the ultrasound because it’s an opportunity to bond with the baby. However, it is a medical test and not something that should be done solely for entertainment purposes. ................
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