A Sound Model of Obstetric Ethics
To the pregnant woman, we have both autonomy-based and beneficence-based obligations. We also have beneficence-based obligations to the fetus when there are linkages between the fetus and the child the fetus will become. One such linkage is viability. Another such linkage occurs when the pregnant women confers on her pre-viable fetus the moral status of being a patient, based on her beliefs and values.
Our obligations to the fetal patient are not absolute obligations; they must in all cases be balanced with autonomy- and beneficence-based obligations to the pregnant woman. Conversely, obligations to the pregnant woman must be balanced in all cases with obligations to the fetal patient.
The view that the fetus has rights, such as an unconditional "right" to life, does not consider the fact that there are irreconcilable differences among and within the major religions of the world – and among cultures, philosophers, and other authoritative sources – on the status of a pre-viable fetus and on fetal rights.
The woman’s "right" to be attended by her obstetrician for her planned home birth as viewed through the pregnant woman’s rights model, on the other hand, does not consider that there are obligations of the medical profession and also of the pregnant woman to the soon-to-be-born child (Obstet. Gynecol. 2011:117:1183-7). Neither does a woman’s "right" to smoke during pregnancy, nor her "right" to have cesarean delivery that is not medically indicated. In the latter case, for example, the professional responsibility model of obstetric ethics tells us we have a strong ethical obligation to try to persuade the pregnant woman not to have a procedure that is medically disadvantageous – an obligation that rights-based models ignore.
A woman who does not avail herself of the option of abortion before fetal viability subsequently has obligations to the soon-to-be-born child. The pregnant woman, in other words, should not be viewed as a person who has absolute rights, but as one who also has obligations to her soon-to-be-born child (Am. J. Obstet. Gynecol. 2009;201:560.e1-6).
Rights-based approaches obscure professional obligations. A professional responsibility model, on the other hand, is professional; it emphasizes obligations we have to both the pregnant woman and the fetal patient, and enables us to avoid extremes that promote unprofessional behavior. The model creates a solid foundation for our care of both the pregnant and fetal patient.
Dr. Chervenak said he has no relevant financial disclosures.
