Ethics (or “Why am I in charge again?”)

by Sarah Luna

Ok, for my discussion section tomorrow, I’m supposed to lead a debate on the ethics of maternal-fetal surgery.

Background: if a fetus has spinal cord defects, surgery must be done to correct these or the fetus will not survive. Up until recently, that surgery was performed after the baby was born. Now researchers are looking at the possibility of conducting that surgery in utero.

The main ethical crux of the issue is whether or not the fetus should be considered a separate patient. Because, of course, surgery on a fetus is necessarily surgery on an autonomous woman.

According to an article by Chervenak, a viable fetus (able to live ex utero) is a always a patient while a pre-viable fetus is only considered a patient if the pregnant woman chooses to continue with the pregnancy.

In order for a new surgery to be studied, it must satisfy these three requirements:

  1. It must be reasonably expected to produce a good outcome.
  2. It must pose the least risk possible to the fetus.
  3. It must have the least risk of maternal mortality.

Ok, that’s reasonable. Do no harm.

Then we get to the issue of informed consent, and I come across this jewel of a paragraph.

In the consent process, words such as ‘mother’, ‘father’,
and ‘baby’ should not be used by investigators, because
these suggest moral relationships and moral statuses that
do not apply. Words such as ‘pregnant woman’, ‘potential
father’, ‘fetus’, and ‘fetal patient’ should be used instead.

…suggest moral relationships and moral statuses that do not apply…

Um, what?  I don’t think I’ve read anything more condescending or offensive in my life. That statement even has the gall to have a citation. At what point then does the the mother (ooh, I used the M word) have a moral relationship with her ova/embryo/fetus/baby/child/offspring/progeny?  Only in Brave New World was “mother” a taboo word.

So this article argues that a fetus should not be considered a separate patient from the pregnant woman which goes back to the idea that “the interest of the women’s physical and social health can be balanced against the interest and viability of and the respect for the embryo or fetus in utero, a human being-to-be” (Boer 1999).

The required readings for my section have other points, too. Should the father’s consent be necessary since he shares none of the medical risks? If mothers demand this in utero surgery, should hospitals refuse since the research does not yet unequivocally support it? Are randomized control trials (like this one) justified?

I don’t even know what to expect from my kids tomorrow.