Legal and ethical issues related to multifetal pregnancy reduction (MPR) in spontaneously conceived twin pregnancies: an interdisciplinary analysis based on a case study

Following the uncertainty expressed by a group of healthcare professionals working in the gynaecology and obstetrics department of an Italian public hospital on how to proceed in the case of patients asking for a multifetal pregnancy reduction (MPR), the need to further investigate the topic led to the constitution of a working group devoted to discussing the topic through an interdisciplinary approach. The purpose of this work is therefore to present the legal and ethical issues addressed through the analysis of: 1) the literature on the subject; 2) legislation, doctrine and case-law related to the foetal reduction procedure; 3) the ethical issues raised by the request and implementation of that procedure. Although, under certain conditions, the legal and ethical legitimacy of this procedure can be sustained, we argue that there is a need for clarification with regard to the definition of the term and its links to existing legislation, as well as for the development of guidelines to assist health professionals.