Treating fetuses: The patient as person
The medical treatment in utero of human beings raises several ethical questions. I argue that treatment is sufficient to establish the fetus as person; and consider how conflicts between the interests of the fetus and mother are to be resolved when such treatment is proposed. My arguments rest upon a ‘relational model’ of ethical discourse derived from H. Richard Niebuhr's “ethics of the fitting.”
I conclude that the limitation of personal autonomy is rarely justified, but may be when direct, grave, harm to others is imminent; and that educative rather than punitive measures are the best prospect for protecting fetal life.
KeywordsMedical Treatment Good Prospect Relational Model Fetal Life Ethical Question
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- 1.The ‘relational model’, as I understand it, is based upon the “ethics of the fitting” articulated by H. Richard Niebuhr, inThe Responsible Self, New York: Harper and Row, 1968. The theory also bears similarities to Christian Existentialism, as defined by Bernard Haring, C.Ss.R., inThe Christian Existentialist, New York: New York University Press, 1968, andMorality is for Persons: The Ethics of Christian Personalism, New York: Farrar, Straus and Giroux, 1971. The essential difference is ontological, viz., that the philosophically oriented ‘relational model’ could operate as an integrated system without assuming the existence of God. Although this absence may be devastatingly critical to theists, I hope that the importance of providing an alternative to the legalism and utilitarianism which dominates current moral philosophy will engender tolerance for this endeavor. It should be further noted that proposed alternatives currently receiving attention, viz. feminist theories which appeal to nurturing or responsibility, are challenging rights based models. The latter, however, still prevail as the status quo to be amended.Google Scholar
- 2.Charles E. Curran,Directions in Fundamental Moral Theology Notre Dame, Indiana: University of Notre Dame Press, 1986.Google Scholar
- 3.See Margaret Farley,Personal Commitments: Beginning, Keeping, Changing, San Francisco: Harper and Row, for an excellent analysis of the phenomenon of personal relationships.Google Scholar
- 4.Dr. Pellegrino is John Carroll Professor of Medicine at Georgetown University Medical School, Director of Georgetown's Center for the Advanced Study of Ethics, and former Director of the Kennedy Institute of Ethics, and has published widely in the field of BioMedical Ethics. This claim prevails throughout the body of his work.Google Scholar
- 5.John A. Robertson and Joseph D. Schulman, “Pregnancy and Prenatal Harm to Offspring: The Case of Mothers with P.K.U.”,Hastings Center Report, August, 1987, pp. 23–32. For an opposite view see Dr. Albert William Liley, “The Unborn Child as a Patient,” National Committee for a Human Life Amendment, Inc., 1707 L Street, N. W., Suite 400, Washington, D.C., 20035 (202) 785–8061.Google Scholar
- 6.Kathleen Nolan, “Genug ist Genug: A Fetus Is Not a Kidney”,Hastings Center Report, December, 1988, presents an important insight concerning the fallacy of assigning the fetus value according to the intentions of the mother. Carol A. Tauer, “The Tradition of Probabilism and the Moral Status of the early Embryo”,Theological Studies, 45 (1984), offers a detailed account of the evolution of the Roman Catholic Church's position that personhood begins at conception.Google Scholar
- 8.Alasdair MacIntyre presents an interesting analysis of the functioning of the United States Supreme Court: “The supreme Court inBakke, as on occasion in other cases, played the role of a peacemaking or truce-keeping body by negotiating its way through an impasse of conflict, not by invoking our shared moral first principles. For our society as a whole has none.”After Virtue, Second Edition, University of Notre Dame Press, Notre Dame, Indiana, 1984, p. 253.Google Scholar
- 11.George Annas, “Pregnant Women as Fetal Containers”,Hastings Center Report, December, 1986, argues that the assumption that the interests of the fetus prevail over those of the mother amounts to requiring “the mother to be the fetus' servant.”Google Scholar
- 14.Dawn Johnsen, “A New Threat to Pregnant Women's Autonomy”,Hastings Center Report, August, 1987, presents a chilling account of the possible injustice which can occur when blame for prenatal injury is borne solely by the expectant mother.Google Scholar