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Clin Perinatol. 1987 Jun;14(2):329-43.

Moral obligations to the not-yet born: the fetus as patient.


The fetus destined to be born rather than aborted has become increasingly an object of medical and moral concern. With considerable justification, women view this concern--which they share to a great degree--with suspicion that it will serve as a pretext for denying them social and economic equality with men. This article attempts to show that practical moral judgments about our obligations to not-yet-born children can be made without falling into the abyss of controversy surrounding abortion. By stressing the similarities in fathers' duties to their born children, we can also counter a measure of our historical propensity to view women's moral duties to their not-yet-born children as the overwhelmingly important feature of their moral lives, and resist the temptation to impose coercive public policies.


Recent debate over fetal surgery, fetal rights, and maternal-fetal conflicts raises important ethical questions concerning the moral status of the fetus. To some extent, the emotionality surrounding this debate can be overcome by distinguishing between the fetus destined to be brought to live birth ("the not-yet-born child") from the fetus that will not be born alive. A central question is whether our moral obligations to the fetus change as a function of viability. While this question may be relevant to abortion debates, it is not salient to our duties to not-yet-born children. Since the fetus will someday be a full person, the timing of nonlethal harms is not pertinent to determining their wrongfulness. Given the link between most discussions of the fetus's moral status and abortion, there is an unfortunate tendency to regard duties toward the fetus as all or none. This dilemma can be overcome by comparing the situations of the not-yet-born and the already born; considerations such as intentions, probability and severity of risk, and duties to others are also relevant. Many decisions are determined by personal conscience, moral persuasion, and social pressure. Thus, a more complex and adequate view of moral issues recognizes that a host of factors may be relevant in a given decision, including promises made, the mother's own interests, obligations to other family members, and the welfare of the not-yet-born child. The state must be cautious in using its power to enforce particular notions of maternal duties, especially since movements directed toward aiding fetuses have historically been motivated by racism and sexism. Our ethical analysis of fetal interventions should take into consideration how certain is the benefit to the fetus, how great are the benefits, how intrusive or harmful will it be to the mother, and whether anything will be lost by waiting until after the child is born.

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