Wilkinson, D.2012-10-082012-10-082012Journal of Medical Ethics, 2012; 38(7):396-3970306-68001473-4257http://hdl.handle.net/2440/73433Heuser and colleagues’ survey of obstetricians provides a valuable insight into the current management of severe fetal anomalies in the United States. Their survey reveals two striking features – that counselling for these anomalies is far from neutral, and that there is significant variability between clinicians in their approach to management. In this commentary I outline the reasons to be concerned about both of these. Directiveness in counselling arguably represents a form of paternalism, and the evident variability in practice is likely the result of physician personal values. However, Heuser’s survey may, by shining a light on practice, provide an important step towards a more consistent approach.enCopyright © 2012 by the BMJ Publishing Group Ltd & Institute of Medical Ethics. All rights reserved.HumansFetal DiseasesPrenatal DiagnosisAbortion, InducedPregnancyPhysiciansFemaleCongenital AbnormalitiesJournal article002012057310.1136/medethics-2012-1005420003058898000022-s2.0-8486399327223930