Ethical Issues in Maternal-Fetal Medicine

Cover......Page 1
Half-title......Page 3
Title......Page 5
Copyright......Page 6
Contents......Page 7
Contributors......Page 10
Acknowledgements......Page 13
1 Introduction: recent debates in maternal–fetal medicine – what are the ethical questions?......Page 15
Power in the obstetrician–patient relationship......Page 16
The impact of new technologies and new diseases......Page 20
Disability and enhancement......Page 24
Difference: gender and culture......Page 26
Conclusion......Page 28
References......Page 29
2 Overview: a framework for reproductive ethics......Page 31
Need for an ethical framework......Page 32
Significance of freedom to procreate......Page 33
Importance of freedom not to procreate......Page 35
Moral standing of the fetus and embryo......Page 36
Assigning priorities......Page 42
Application of the framework......Page 44
References......Page 48
I Generic issues in pregnancy......Page 51
Introduction......Page 53
Liberalism and conflicting interests in medical decision-making......Page 55
From the universal protection of human rights to ‘laissez-faire ethics’......Page 56
Traditional societies and cultural relativism......Page 58
Women’s health in a patriarchal society......Page 59
Feminist bioethics and respect for difference......Page 63
The contradiction of relativism......Page 66
Cultural identity vs. moral identity......Page 70
Towards a global bioethics......Page 71
Conclusion......Page 72
References......Page 73
Setting the scene......Page 75
The implications of a positive result......Page 78
The relationship between the health professional and the patient......Page 80
The ethics of anonymised unlinked screening for HIV in pregnancy......Page 81
The ethics of named testing......Page 84
Confidentiality and disclosure to third parties......Page 89
Therapeutic research in pregnancy: ethical issues in placebo-controlled trials......Page 90
References......Page 93
5 Genetic screening: should parents seek to perfect their children genetically?......Page 101
Do parents have a right to enhance their children genetically?......Page 102
Do parents have a duty to enhance their children genetically?......Page 105
Should parents genetically enhance their children?......Page 108
References......Page 113
6 Is there a duty not to reproduce?......Page 115
The ‘harms’ of reproduction......Page 116
The ‘costs’ of reproduction......Page 117
Does harm/cost = duty not to reproduce?......Page 118
A qualified reproductive right?......Page 119
Enforcing a duty not to reproduce – the role of the law?......Page 120
Civil law liability......Page 122
References......Page 125
7 Between fathers and fetuses: the social construction of male reproduction and the politics of fetal harm......Page 127
Social constructions of maternity and paternity......Page 128
‘Crack babies’ and ‘pregnant addicts’......Page 129
Virile fathers and the ‘all or nothing’ sperm theory......Page 132
The evidence of male-mediated developmental toxicology......Page 134
Press coverage of male-mediated harm......Page 138
Paternal effects and ‘political correctness’......Page 140
References......Page 141
The moral relationship of mother and fetus......Page 145
Offers and threats......Page 150
Coercion......Page 152
Punishment for reckless endangerment......Page 153
The will of a drug-taker......Page 154
The complexity of judging and influencing maternal behaviour......Page 156
No less drastic method for achieving the same end......Page 157
Conclusion......Page 158
References......Page 159
II Inception of pregnancy: new reproductive technologies......Page 161
Introduction......Page 163
Embryo research and screening......Page 164
Cryopreservation of reproductive tissues......Page 167
Cloning and the human embryo......Page 168
References......Page 172
Introduction......Page 175
A case of high risk pregnancy......Page 176
Risks to the mother, the fetus and the neonate......Page 177
Case discussion......Page 178
References......Page 180
Introduction......Page 181
Donor anonymity......Page 182
Secrecy and the family......Page 186
Conclusion......Page 192
References......Page 193
III First and second trimester......Page 195
Introduction......Page 197
Consequences of fetal screening......Page 198
Special features of fetal screening......Page 200
Comparison to other perinatal interventions......Page 202
Integration of ethics and social consequences into health technology assessment......Page 204
What can be done?......Page 205
References......Page 206
Prenatal counselling......Page 209
Advantages of prenatal counselling......Page 210
Disadvantages of prenatal counselling......Page 211
Radical views of disabled people......Page 213
Research with disabled people......Page 215
Examples from the interviews......Page 217
Discussion......Page 220
The implications of the interviews for prenatal counselling and maternal–fetal relations......Page 221
References......Page 224
The power of problem definition......Page 227
Problem definition: constitutionalism and politics......Page 228
The traditional model of motherhood and abortion rights......Page 230
Lifeboat ethics and justification for killing......Page 232
The problem with the sacrifice model......Page 234
Abortion and the traditional model of motherhood......Page 235
From choice to consent......Page 236
Self-defence......Page 237
Self-defence and abortion rights......Page 239
What the fetus does......Page 240
Contingent equal protection......Page 241
Abortion as role change......Page 242
Roles and goals......Page 243
References......Page 244
Background: why does ownership of embryonic and fetal tissue matter?......Page 247
Property, persons, pregnancy and progeny......Page 250
Status quo......Page 253
Strict regulation of commercialization......Page 254
Vesting control over all tissue in the mother, and treating alienation of it from her as theft......Page 256
Acknowledgement......Page 257
References......Page 258
16 The fewer the better? Ethical issues in multiple gestation......Page 261
Methods of fetal or embryo termination in multiple gestation......Page 262
More on terminology......Page 264
Egalitarian feminism and FTPP cases......Page 265
Conclusion......Page 272
References......Page 273
IV Third trimester......Page 275
The procedure......Page 277
Effects and complications of Caesarean section......Page 278
Epidemiology......Page 279
A woman’s right to choose a Caesarean section......Page 280
Why women ask for Caesarean section......Page 282
Forced Caesarean section: the law in England and Wales......Page 283
Ethical issues......Page 291
Medical issues......Page 293
References......Page 294
Introduction......Page 299
The advice......Page 300
Implications of the compliance and non-compliance framework......Page 303
A closer look at judgements of non-compliance......Page 306
Deliberate refusals: epistemological conflict......Page 308
Failure of understanding......Page 310
Inadvertent non-compliance......Page 311
Judgments of non-compliance in review......Page 312
References......Page 314
V Neonatal life......Page 317
19 Do new reproductive technologies benefit or harm children?......Page 319
Existence itself......Page 320
Loving, motivated, prosperous parents......Page 321
Avoidance of disabilities......Page 322
Genetic links and eugenicist tendencies......Page 323
Sexism, heterosexism, racism and NRTs......Page 325
Possible dangers to children’s health......Page 326
Contract pregnancy and the sale of children......Page 327
Denial of the right of children to know the identity of their progenitors......Page 329
Conclusion......Page 330
References......Page 331
Beginning together......Page 335
Worthwhile lives?......Page 336
Morally wrong worthwhile lives?......Page 337
Beginning to diverge......Page 338
Who suffers?......Page 339
Who is harmed/wronged by disability?......Page 341
Two separate questions......Page 342
Bennett’s position......Page 343
Harris’s position......Page 344
Conclusions......Page 345
References......Page 348
Introduction......Page 349
Background......Page 350
Rights and duties of parents and doctors in the newborn period......Page 351
The issues......Page 352
Knowledge, evidence and certainty......Page 354
Parental and societal pressures and second opinions......Page 356
Conclusion......Page 357
References......Page 358
Index......Page 361