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Vol. 30, No. 1, 2011
Issue release date: August 2011
Free Access
Fetal Diagn Ther 2011;30:1–8
(DOI:10.1159/000324540)

Ethical Issues on Pregnancy Termination: Impact of New Imaging Modalities

Gorincour G.a, b · Tassy S.a · Siméoni U.c · Le Coz P.a
aMediterranean Ethical Forum, EA 3783, Université de la Méditerranée, bMultidisciplinary Center for Prenatal Diagnosis, La Timone Hospital, and cDivision of Neonatology, La Conception Hospital, Marseille, France
email Corresponding Author

Abstract

Objective: To explicate the ontological statuses of both the fetus and neonate as a basis for clinical ethical judgments about the obligations of both physicians and pregnant women to protect the life and health of both the fetus and the neonate. Methods: Despite drastic changes in perinatology, there is still a legal separation between fetuses and neonates. Neonatal status remains specific because of the prohibition of ‘transgressing human life’. Nevertheless, the concept of a ‘prenatal human being’ recently emerged. While new technologies blur the fetus/neonate borderline, why is it still legal in many European countries to terminate a fetal life in the late stages of pregnancy? One might even support the idea that what is authorized before birth should also be after, thereby ‘fetalizing’ neonates. Results: The ‘personalistic’ approach is against this ‘fetalization’, considering that terminating a neonate life is ‘transgressive’. The ‘utilitarian’ model considers we cannot decide what is good for someone else, which justifies terminating the life of neonates who are not persons yet. A phenomenological view supports the ontological difference on our perceptions, differing whether we observe ultrasound fetal images or real neonatal pictures. Conclusion: This does not mean the weight of fetal images should be underestimated.


 goto top of outline Key Words

  • Fetus
  • Neonate
  • Termination of life
  • Autonomy
  • Doing good
  • Doing no harm
  • Fairness
  • Transgression
  • Utilitarianism
  • Phenomenology
  • Empathy

 goto top of outline Abstract

Objective: To explicate the ontological statuses of both the fetus and neonate as a basis for clinical ethical judgments about the obligations of both physicians and pregnant women to protect the life and health of both the fetus and the neonate. Methods: Despite drastic changes in perinatology, there is still a legal separation between fetuses and neonates. Neonatal status remains specific because of the prohibition of ‘transgressing human life’. Nevertheless, the concept of a ‘prenatal human being’ recently emerged. While new technologies blur the fetus/neonate borderline, why is it still legal in many European countries to terminate a fetal life in the late stages of pregnancy? One might even support the idea that what is authorized before birth should also be after, thereby ‘fetalizing’ neonates. Results: The ‘personalistic’ approach is against this ‘fetalization’, considering that terminating a neonate life is ‘transgressive’. The ‘utilitarian’ model considers we cannot decide what is good for someone else, which justifies terminating the life of neonates who are not persons yet. A phenomenological view supports the ontological difference on our perceptions, differing whether we observe ultrasound fetal images or real neonatal pictures. Conclusion: This does not mean the weight of fetal images should be underestimated.

Copyright © 2011 S. Karger AG, Basel


 goto top of outline References
  1. Rappaport VJ: Prenatal diagnosis and genetic screening – integration into prenatal care. Obstet Gynecol Clin North Am 2008;35:435–458, ix.

    External Resources

  2. Lee SJ, Ralston HJ, Drey EA, Partridge JC, Rosen MA: Fetal pain: a systematic multidisciplinary review of the evidence. JAMA 2005;294:947–945.
  3. Copelon R, Zampas C, Brusie E, Devore J: Human rights begin at birth: international law and the claim of fetal rights. Reprod Health Matters 2005;13:120–129.

    External Resources

  4. Sureau C: Son nom est personne. Paris, Albin Michel, 2005.
  5. Beauchamp TL, Childress J: Principles of Biomedical Ethics, ed 5. Oxford, Oxford University Press, 2001.
  6. Elster J, Herpin N (eds): ‘The Ethics of Medical Choice’; in The Ethics of Medical Choice. Social Change in Western Europe. London, Pinter/St. Martin’s Press, 1994.
  7. Gatherer A: Ethics and medical decision-making. Family Practice 2003;20:223-a.
  8. Stringer M, Shaw VD, Savani RC: Comfort care of neonates at the end of life. Neonatal Netw 2004;23:41–46.
  9. Official Journal of the French Republic. 2005. Loi No 2005-370 du 22 avril 2005. Journal Officiel No 95.
  10. National Ethics Committee. Réflexions éthiques autour de la réanimation néonatale, avis No 65. 2000. http://www.ccne-ethique.fr.
  11. National Ethics Committee. Avis sur les prélèvements de tissus d’embryons et de fœtus humains morts, à des fins thérapeutiques, diagnostiques et scientifiques, avis No 1. 1984. http://www.ccne-ethique.fr.
  12. Gold F, Laugier J: Decision about stopping therapy in neonatal intensive care units. Taking the initiative in the management of handicaps. Arch Fr Pediatr 1992;49:5–7.
  13. Singer P, Kuhse H: Should the Baby Live? Oxford, University Press Oxford, 1994.
  14. Singer P: Voluntary euthanasia: a utilitarian perspective. Bioethics 2003;17:526–541.

    External Resources

  15. Mill JS: L’utilitarisme. Paris, Champs Flammarion, 1988.
  16. Mill JS: On Liberty and Others Essays: Oxford World’s Classics. New York, Oxford University Press, 1991.
  17. Bentham J: Guaranties against Abuse of Power and Other Writings on Political Liberty. Paris, Editions Rue d’Ulm, 2001.
  18. Niessen F, Vial M, Magny JF, Dauphin F: Les seuils de développement de l’être humain et la décision éthique dans la pratique obstétrico-pédiatrique. Reprod Hum Horm 1997;10:66–78.
  19. Husserl E: Leçons pour une phénoménologie de la conscience intime du temps: coll ‘Epiméthée’. Paris, PUF, 1996, section II.
  20. Lévinas E: Ethique et infini. Paris, Livre de Poche, 1984.
  21. Griffiths PE: What Emotions Really Are. Chicago, University of Chicago Press, 1997.
  22. Loewenstein G, Lerner JS: The role of affect in decision making; in Davidson RJ, Goldsmith HH, Scherer KR (eds): Handbook of Affective Science. Oxford, Oxford University Press, 2003.
  23. Baron-Cohen S, Tager-Flusberg H, Cohen DJ: Understanding Other Minds, Perspectives from Autism. New York, Oxford University Press, 1993.
  24. Gourand L: L’échographiste et l’accès au ventre. Rev Fr Psychosom 2004;26:71–83.
  25. Lenhardt F, Gourand L: Echography and prenatal diagnosis (in French). Soins Gynecol Obstet Pueric Pediatr 1993;147–148:29–33.
  26. Gorincour G, Tassy S, Le Coz P: The moving face of the fetus – the changing face of medicine. Ultrasound Obstet Gynecol 2006;28:979–980.
  27. Missonnier S: L’enfant virtuel et les jeux échographiques, Champ Psychosomatique 2006;43:37–53.

    External Resources

  28. Maisonneuve J: Les conduites rituelles. Paris, PUF, 1988.
  29. Missonnier S: Entre extrême incertitude et extrême onction: le diagnostic fœtal. Champ Psychosomatique 2005;45:71–84.

    External Resources

  30. National Ethics Committee. A propos de la conservation des corps des fœtus et enfants mort-nés, Réponse à la saisine du Premier Ministre, avis No 89. 2005. http://www.ccne-ethique.fr.
  31. Dageville C, Rameix S, Andrini P, Betrémieux P, Jarreau PH, Kuhn P, Oriot D: End of life in neonatal medicine in the light of French law. Gynecol Obstet Fertil 2008;36:571–581.

 goto top of outline Author Contacts

Dr. Guillaume Gorincour
Mediterranean Ethical Forum, EA 3783
Université de la Méditerranée, La Timone Hospital
264, rue Saint-Pierre, FR–13385 Marseille (France)
Tel. +33 4 9138 6797, E-Mail Guillaume.GORINCOUR@ap-hm.fr


 goto top of outline Article Information

Received: November 2, 2010
Accepted after revision: January 17, 2011
Published online: March 3, 2011
Number of Print Pages : 8
Number of Figures : 0, Number of Tables : 0, Number of References : 31


 goto top of outline Publication Details

Fetal Diagnosis and Therapy (Clinical Advances and Basic Research)

Vol. 30, No. 1, Year 2011 (Cover Date: August 2011)

Journal Editor: Gratacós E. (Barcelona)
ISSN: 1015-3837 (Print), eISSN: 1421-9964 (Online)

For additional information: http://www.karger.com/FDT


Copyright / Drug Dosage / Disclaimer

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

Abstract

Objective: To explicate the ontological statuses of both the fetus and neonate as a basis for clinical ethical judgments about the obligations of both physicians and pregnant women to protect the life and health of both the fetus and the neonate. Methods: Despite drastic changes in perinatology, there is still a legal separation between fetuses and neonates. Neonatal status remains specific because of the prohibition of ‘transgressing human life’. Nevertheless, the concept of a ‘prenatal human being’ recently emerged. While new technologies blur the fetus/neonate borderline, why is it still legal in many European countries to terminate a fetal life in the late stages of pregnancy? One might even support the idea that what is authorized before birth should also be after, thereby ‘fetalizing’ neonates. Results: The ‘personalistic’ approach is against this ‘fetalization’, considering that terminating a neonate life is ‘transgressive’. The ‘utilitarian’ model considers we cannot decide what is good for someone else, which justifies terminating the life of neonates who are not persons yet. A phenomenological view supports the ontological difference on our perceptions, differing whether we observe ultrasound fetal images or real neonatal pictures. Conclusion: This does not mean the weight of fetal images should be underestimated.



 goto top of outline Author Contacts

Dr. Guillaume Gorincour
Mediterranean Ethical Forum, EA 3783
Université de la Méditerranée, La Timone Hospital
264, rue Saint-Pierre, FR–13385 Marseille (France)
Tel. +33 4 9138 6797, E-Mail Guillaume.GORINCOUR@ap-hm.fr


 goto top of outline Article Information

Received: November 2, 2010
Accepted after revision: January 17, 2011
Published online: March 3, 2011
Number of Print Pages : 8
Number of Figures : 0, Number of Tables : 0, Number of References : 31


 goto top of outline Publication Details

Fetal Diagnosis and Therapy (Clinical Advances and Basic Research)

Vol. 30, No. 1, Year 2011 (Cover Date: August 2011)

Journal Editor: Gratacós E. (Barcelona)
ISSN: 1015-3837 (Print), eISSN: 1421-9964 (Online)

For additional information: http://www.karger.com/FDT


Copyright / Drug Dosage

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

References

  1. Rappaport VJ: Prenatal diagnosis and genetic screening – integration into prenatal care. Obstet Gynecol Clin North Am 2008;35:435–458, ix.

    External Resources

  2. Lee SJ, Ralston HJ, Drey EA, Partridge JC, Rosen MA: Fetal pain: a systematic multidisciplinary review of the evidence. JAMA 2005;294:947–945.
  3. Copelon R, Zampas C, Brusie E, Devore J: Human rights begin at birth: international law and the claim of fetal rights. Reprod Health Matters 2005;13:120–129.

    External Resources

  4. Sureau C: Son nom est personne. Paris, Albin Michel, 2005.
  5. Beauchamp TL, Childress J: Principles of Biomedical Ethics, ed 5. Oxford, Oxford University Press, 2001.
  6. Elster J, Herpin N (eds): ‘The Ethics of Medical Choice’; in The Ethics of Medical Choice. Social Change in Western Europe. London, Pinter/St. Martin’s Press, 1994.
  7. Gatherer A: Ethics and medical decision-making. Family Practice 2003;20:223-a.
  8. Stringer M, Shaw VD, Savani RC: Comfort care of neonates at the end of life. Neonatal Netw 2004;23:41–46.
  9. Official Journal of the French Republic. 2005. Loi No 2005-370 du 22 avril 2005. Journal Officiel No 95.
  10. National Ethics Committee. Réflexions éthiques autour de la réanimation néonatale, avis No 65. 2000. http://www.ccne-ethique.fr.
  11. National Ethics Committee. Avis sur les prélèvements de tissus d’embryons et de fœtus humains morts, à des fins thérapeutiques, diagnostiques et scientifiques, avis No 1. 1984. http://www.ccne-ethique.fr.
  12. Gold F, Laugier J: Decision about stopping therapy in neonatal intensive care units. Taking the initiative in the management of handicaps. Arch Fr Pediatr 1992;49:5–7.
  13. Singer P, Kuhse H: Should the Baby Live? Oxford, University Press Oxford, 1994.
  14. Singer P: Voluntary euthanasia: a utilitarian perspective. Bioethics 2003;17:526–541.

    External Resources

  15. Mill JS: L’utilitarisme. Paris, Champs Flammarion, 1988.
  16. Mill JS: On Liberty and Others Essays: Oxford World’s Classics. New York, Oxford University Press, 1991.
  17. Bentham J: Guaranties against Abuse of Power and Other Writings on Political Liberty. Paris, Editions Rue d’Ulm, 2001.
  18. Niessen F, Vial M, Magny JF, Dauphin F: Les seuils de développement de l’être humain et la décision éthique dans la pratique obstétrico-pédiatrique. Reprod Hum Horm 1997;10:66–78.
  19. Husserl E: Leçons pour une phénoménologie de la conscience intime du temps: coll ‘Epiméthée’. Paris, PUF, 1996, section II.
  20. Lévinas E: Ethique et infini. Paris, Livre de Poche, 1984.
  21. Griffiths PE: What Emotions Really Are. Chicago, University of Chicago Press, 1997.
  22. Loewenstein G, Lerner JS: The role of affect in decision making; in Davidson RJ, Goldsmith HH, Scherer KR (eds): Handbook of Affective Science. Oxford, Oxford University Press, 2003.
  23. Baron-Cohen S, Tager-Flusberg H, Cohen DJ: Understanding Other Minds, Perspectives from Autism. New York, Oxford University Press, 1993.
  24. Gourand L: L’échographiste et l’accès au ventre. Rev Fr Psychosom 2004;26:71–83.
  25. Lenhardt F, Gourand L: Echography and prenatal diagnosis (in French). Soins Gynecol Obstet Pueric Pediatr 1993;147–148:29–33.
  26. Gorincour G, Tassy S, Le Coz P: The moving face of the fetus – the changing face of medicine. Ultrasound Obstet Gynecol 2006;28:979–980.
  27. Missonnier S: L’enfant virtuel et les jeux échographiques, Champ Psychosomatique 2006;43:37–53.

    External Resources

  28. Maisonneuve J: Les conduites rituelles. Paris, PUF, 1988.
  29. Missonnier S: Entre extrême incertitude et extrême onction: le diagnostic fœtal. Champ Psychosomatique 2005;45:71–84.

    External Resources

  30. National Ethics Committee. A propos de la conservation des corps des fœtus et enfants mort-nés, Réponse à la saisine du Premier Ministre, avis No 89. 2005. http://www.ccne-ethique.fr.
  31. Dageville C, Rameix S, Andrini P, Betrémieux P, Jarreau PH, Kuhn P, Oriot D: End of life in neonatal medicine in the light of French law. Gynecol Obstet Fertil 2008;36:571–581.