Ethnographic Insights Regarding the “Social Role” and “Moral Status” of the Fetus as “Patient”: Comparing Developed (United States &amp; Sweden) and Developing (India) Countries
Authors: Catherine Myser
Journal: The American Journal of Bioethics (2008)

Click to increase image sizeClick to decrease image size Notes 1. Almost every physician I interviewed told me it was “illogical” and “arbitrary,” but “practical,” to establish a cut-off at, e.g., 18 weeks gestation, for decisions to restrict abortions. Their primary concern was to avoid a fetus being aborted when it was “viable,” and could thus be “salvaged” by neonatologists. It is also interesting to note that the abortion committee of the National Board of Health and Welfare (Stockholm, Sweden) allows 80% to 99% of late abortions sought, according to my interviews with current and past committee members, and that those interviewed could not identify the criteria used for such decision-making (cf. Justitiedepartementet, Utredningen om det Ofodda Barnet 1989, 131, which lists these criteria). 2. It must be noted, however, that this absolute “right” of determination does not hold after the birth of the fetus, because it is grounded in the fact of the fetus's physical connectedness and relationship with the pregnant woman's body and “integrity.” In neonatal medicine in Sweden, health care professionals put their beneficence-based obligations to the infant patient, who can be directly observed and evaluated without physical damage or stress to the mother, before autonomy-based obligations to the mother and father. 3. This law may influence the Hindu more than the Muslim or Christian in India, as these religions incorporate stronger prohibitions against abortion, except in cases in which the pregnant woman's survival or health are threatened by the fetus (see, for example, CitationVerma and Singh 1989). 4. At All India Institution of Medical Sciences (AIIMS) in New Delhi, India, where I conducted my research, prenatal diagnosis for sex selection is not carried out, although there are private clinics offering this procedure in New Delhi. Also, Bombay (in Maharashtra) has passed a law against prenatal diagnosis for sex selection, which may be enacted by other states as well. 5. One possible exception brought to my attention is a case in which the pregnant woman at risk is a man's second wife, taken by the man solely in the hope of conceiving a male child, and the fetus at risk has been prenatally diagnosed to be male. Here, the “preciousness” of the male fetus might outweigh whatever interests the pregnant woman might be seen to have, at least according to the prospective father, who will be the decision-maker after the options open to him have been discussed with healthcare professionals. 6. See, for example, CitationBrown (2008). Also, I myself once consulted in two clinics at the same hospital—maternal–fetal medicine and neurosurgery—on the case of a pregnant patient with an aneurysm, in which the pregnant woman was treated only from the head up in neurosurgery, and in maternal–fetal medicine her aneurysm and implications for her own and fetal health were obscured in significant ways. Because no other staff member consulted on both clinics, this was otherwise not recognized by either clinic.