The parents of a girl with "severe" disabilities have argued Canberra Hospital owes them millions, after its staff failed to flag a potential disorder before she was born.
A Court of Appeal judgment published on Thursday said Einas Nouri and her partner Musab Shaor were told they were 19 weeks pregnant with twins on July 8, 2011.
An ultrasound indicated one twin could have a heart problem, and the couple was informed.
But behind closed doors - and several tests later, on September 6 - doctors discussed it was possible the twin also had an abnormal connection between her esophagus and trachea.
Neither parent was told, and their daughter was born with the disorder on November 3.
The judgment said she requires 24-hour care as a result of her disabilities, which also include vertebral anomalies, anal atresia, heart defects, kidney abnormalities, and limb defects.
"Apart from [their daughter], [the couple] have three other children and their lives have been irreparably changed due to the additional obligations that come with raising a severely disabled child," the judgment said.
In initial court proceedings against Canberra Hospital, Ms Nouri and Mr Shaor said they would have terminated the disabled twin if they were told about the esophagus disorder on September 22.
Ms Nouri had one of several procedures to reduce fluid around an embryo on September 15. September 22 was the first occasion doctors had sighted the twins via ultrasound since the procedure and their September 6 discussion.
Ms Nouri was about 30 weeks pregnant at the time, the judgment said.
Supreme Court Justice Michael Elkaim in 2018 found the Canberra Hospital did breach its duty of care, but Ms Nouri and Mr Shaor could not prove the hospital should be liable for damages.
Damages were assessed at more than $1.8 million - to be recoverable until the girl turned 18 - but were not awarded to the couple.
Justice Elkaim found that even if Ms Nouri and Mr Shaor had been told on September 22 of their twin's disorder, they may not have been able to terminate the pregnancy.
The couple had argued in court they would have travelled to the United States for an abortion, because no Australian practitioner would perform one at more than 30 weeks.
The Court of Appeal upheld Justice Elkaim's decision on Thursday after Ms Nouri and Mr Shaor rejected the finding.
The published judgment said: "It is certainly theoretically possible that a person in Ms Nouri's position, with an extraordinary degree of determination, effort and organisation, could have achieved the outcome of a selective termination.
"However, the absence of a firm diagnosis, the lack of encouragement that she would have received from her treating medical specialists, the need to locate and decide to be treated by a suitable practitioner in the US, the risks of [travelling] ... [and] the significant expense that would be involved ... mean that the balance of probabilities is not in favour of her having achieved that."
Ms Nouri and Mr Shaor also argued on appeal that a doctor should have told them their daughter had a suspected missing shunt as of August 8, 2011. The shunt regulated blood flow to the foetal heart, the judgment said.
Three Court of Appeal justices found it was "not unreasonable" for the information to have not been disclosed, given a paediatric cardiologist later found the twin's heart had no structural abnormalities.
The justices made no finding about Ms Nouri and Mr Shaor's claim that they should be awarded damages beyond their daughter turning 18.
Ms Nouri and Mr Shaor's appeal was dismissed on Thursday.