Introduction
Maternal-fetal conflicts is one of the primary topics of obstetric ethics. The classical example of conflicting interests between a pregnant woman and her gestating fetus is derived from a rights based model and often leads to polarized debates around a woman’s right to control her body and a fetus’s right to life. (Chervenak et al 2011)
These situations are particularly tricky in cases where maternal behavior or actions may put the fetus at risk such as in consumption of illicit and dangerous drugs, failed suicide attempts, or simple refusal to take prescribed medications. In many countries these behaviors are criminalized and pregnant women often face jail time and/or fines. (Mills 2014)
Over the years critics have denounced such practices, for example attorney Lynn Paltrow provocatively asked “Can becoming pregnant be a crime?” to highlight the fact that addiction often predated pregnancy and that women using drugs causing fetal harm did not do so willingly or with intent to harm their fetus. (Harris 2000)
Upon further ethical scrutiny a new outlook has evolved and maternal-fetal ethics are now often construed from a more relational standpoint. Going beyond rigid universal principles to find answers permits ethicists and medical professionals to develop more nuanced accounts of the relationship between a physician, a mother, a fetus and the socio-material environment.
Assigned Readings
Harris, L. H. (2000). Rethinking maternal-fetal conflict: gender and equality in perinatal ethics. Obstetrics and Gynecology. 96(5 Pt 1):786-791. DOI: 10.1016/s0029-7844(00)01021-8. PMID: 11042319.
Thesis: Harris offers an alternative to the conflicts based model that puts maternal and fetal rights in opposition. This new model focuses on the mutual needs of pregnant women and fetuses and attempts to move away from criminalization and encourages practitioners to attempt to understand the decisions and actions of pregnant women within their social networks and communities in order to promote prevention of fetal harm.
Chervenak, F. A., McCullough, L. B., & Brent, R. L. (2011). The professional responsibility model of obstetrical ethics: avoiding the perils of clashing rights. American journal of obstetrics and gynecology, 205(4), 315.e1–315.e3155. https://doi.org/10.1016/j.ajog.2011.06.006
Thesis: Chervenak et al argue that the polarized rights based model conflicting maternal and fetal interest is reductionist and fallacious. They propose a science informed, compassionate model of care centered around the principle of beneficence and professional responsibility to one’s patients.
Discussion Questions
- How are we to balance the beneficence based obligations to the viable fetal patient (or pre-viable fetus if the woman has conferred upon in the status of a patient), the beneficence based obligations to the pregnant woman, and the autonomy based obligations to the woman (note this is not discussed in the article, we are looking for your own ideas!). More generally, how do we balance different obligations in bioethics cases?
- Harris rejects models such as Chervenak et al., or “conflict based models” where the moral obligations to (or rights of) the fetus are seen to conflict with the moral obligations to (or rights of) the pregnant woman (and also principle based models that rely on concepts of autonomy and beneficence) in favor of a more “relational, care-based, equality driven model”. Please explain what she finds wrong with the conflict or principle based models.
- Explain Harris’s “alternative perinatal ethical model” in theory and practice. Please evaluate the model—is it ethically defensible, conceptually clear, practically useful?
- Do you think Harris’s model is an alternative conceptual model/framework, or could it be considered as providing tips on how to do a better job of employing principle based models such as the one developed by Chervenak et al.? [see Philosophical Foundations in the menu tab to revisit principlism/principle based ethics]
References and Additional Resources
Journal Articles
Liaschenko, J. & DeBruin, D. & Marshall, M. F. (2011). The Two-Patient Framework for Research During Pregnancy: A Critique and a Better Way Forward. The American journal of bioethics : AJOB. 11. 66-8. 10.1080/15265161.2011.566032.
Scott C. (2017). Resolving Perceived Maternal-Fetal Conflicts Through Active Patient-Physician Collaboration. The American journal of bioethics : AJOB, 17(1), 100–102. https://doi.org/10.1080/15265161.2016.1251636
Romanis E.C. et al. (2021). Reviewing the womb. Journal of Medical Ethics. 47:820-829.
Mills, C. (2014). Making Fetal Persons: Fetal Homicide, Ultrasound, and the Normative Significance of Birth. philoSOPHIA 4(1), 88-107. https://www.muse.jhu.edu/article/549346.
Kingma, E. (2019). Were You a Part of Your Mother?, Mind. 128(511), 609–646, https://doi.org/10.1093/mind/fzy087
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