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RETHINKING MATERNAL-FETAL CONFLICT: GENDER AND EQUALITY IN PERINATAL ETHICS

Harris, Lisa H. MD

CLINICAL COMMENTARY
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Practitioners who care for pregnant women face dilemmas when their patients use illicit drugs, reject medical recommendations, or cause fetal harm. Many ethics scholars characterize those situations as maternal-fetal conflicts. In conflict-based models, maternal rights are considered to conflict with fetal rights, or moral obligations owed to pregnant women are considered to conflict with those owed to their fetuses. I offer an alternative model of pregnancy ethics by applying relational and equality-based moral theories to situations of fetal harm by pregnant women. In this model, clinicians faced with ethical dilemmas should attempt to understand pregnant women and their decisions within their broad social networks and communities, ask how the clinician's personal standpoint influences outcomes judged to be ethical, and determine whether the clinician's ethical formulations reduce or enhance existing gender, class, or racial inequality. This model focuses on the mutual needs of pregnant women and fetuses rather than on their mutually exclusive needs. It also avoids many pitfalls of traditional ethical formulations, specifically their tendency to neglect gender-specific modes of moral reasoning, their implicit assumptions that application of universal principles like autonomy and beneficence results in objective ethical solutions, and their failure to account for the ways that projecting fetal needs perpetuates social inequalities. This model provides the ethical foundations for moving law and policy away from criminalization and toward prevention of prenatal harm.

A perinatal ethical model based in relational ethics and equality has advantages over traditional models that view a pregnant woman and her fetus in conflict.

University of Michigan Health System, Department of Obstetrics and Gynecology, Robert Wood Johnson Clinical Scholars Program, Ann Arbor, Michigan.

Address reprint requests to: Lisa H. Harris, MD, University of Michigan Health System, Robert Wood Johnson Clinical Scholars Program, 6312 Medical Science Building I, 1150 West Medical Center Drive, Ann Arbor, MI 48109-0604. E-mail: lhharris@umich.edu

This work was supported by the Robert Wood Johnson Foundation.

Received February 15, 2000, Received in revised form June 5, 2000, Accepted July 7, 2000

© 2000 The American College of Obstetricians and Gynecologists