Ethics is an essential dimension of the clinical management of pregnancies complicated by fetal anomalies. Utilizing the ethical principles of beneficence and respect for autonomy, this review first sets out the ethical concept of the fetus as a patient. This concept provides the basis for a comprehensive approach to ethical issues in the management of pregnancies complicated by fetal anomalies. Practical, ethically justified guidance is given for the physician's role in counseling pregnant women about aggressive management, termination of pregnancy, selective termination of multifetal pregnancies, nonaggressive management, cephalocentesis, and fetal research.