Research to improve the health of pregnant and fetal patients presents ethical challenges to clinical investigators, institutional review boards, funding agencies, and data safety and monitoring boards. The Common Rule sets out requirements that such research must satisfy but no ethical framework to guide their application. We provide such an ethical framework, based on the ethical concept of the fetus as a patient. We offer criteria for innovation and for Phase I and II and then for Phase III clinical (...) trials to improve the health of pregnant patients and of fetal patients and also criteria to responsibly manage the transition from investigation to clinical practice. Basing ethical criteria for research involving pregnant women on the ethical concept of the fetus as a patient insulates the proposed ethical framework and therefore research on pregnant women from the divisive and politicized concepts and discourses of personhood, fetal rights, and unborn child. (shrink)

The use of ultrasonic scans in pregnancy makes it possible to observe the fetus undisturbed in the womb. Dr Alessandra Piontelli has done what no one has done before: she observed eleven fetuses in the womb using ultrasound scans, and then observed their development at home from birth up to the age of four years. She includes a description of the psychoanalytic psychotherapy of one of the research children, and the psychoanalysis of five other very young children whose behaviour (...) in analysis suggested that they were deeply preoccupied with their experience in the womb. Dr Piontelli has discovered what many parents have always thought - that each fetus, like each newborn baby, is a highly individual creature. By drawing on her experience as a child psychotherapist and psychoanalyst as well as on her observational research, she is able to investigate issues relating to individuality, psychological birth and the influence of maternal emotions during pregnancy. Her findings demonstrate clearly how psychoanalytical evidence enhances, deepens and supports observational data on the remarkable behavioural and psychological continuities between pre-natal and post-natal life. (shrink)

Interventions performed on a pregnant woman's body can affect the fetus in multiple ways. Such effects can be harmful to beneficial to the fetus. Unfortunately, the effects of new drugs and compoun...

This chapter contains sections titled: Abortion and Mother‐Fetus Conflict Moral Obligations to the Unborn The Obstetrical Cases: Forced Cesareans Fetal Surgery Conclusion References Further reading.

Due to new developments in prenatal testing and therapy the fetus is increasingly visible, examinable and treatable in prenatal care. Accordingly, physicians tend to perceive the fetus as a patient and understand themselves as having certain professional duties towards it. However, it is far from clear what it means to speak of a patient in this connection. This volume explores the usefulness and limitations of the concept of ¿fetal patient¿ against the background of the recent seminal developments in (...) prenatal or fetal medicine. It does so from an interdisciplinary and international perspective. Featuring internationally recognized experts in the field, the book discusses the normative implications of the concept of ¿fetal patient¿ from a philosophical-theoretical as well as from a legal perspective. This includes its implications for the autonomy of the pregnant woman as well as its consequences for physician-patient-interactions in prenatal medicine. (shrink)

Much of the discussion surrounding the ethics of abortion has centered around the notion of personhood. This is because many philosophers hold that the morality of abortion is contingent on whether the fetus is a person - though, of course, some famous philosophers have rejected this thesis (e.g. Judith Thomson and Don Marquis). In this article, I construct a novel argument for the immorality of abortion based on the notion of impairment. This argument does not assume that the (...) class='Hi'>fetus is a person - indeed, I concede (for the sake of argument) that the fetus is not a person - and hence the morality of abortion is not contingent on whether the fetus is a person. I finish by answering a plethora of objections to my argument, concluding that none of them are successful. (shrink)

Critique of J.J. Thomson's well-known defense of abortion. Tries to show that Thomson is wrong that abortion is a violation of the fetus's right to life because there is an important difference between the way the fetus is dependent on the pregnant woman and the way the patient is dependent on the violinist.

Since the late 1980s, the fetal origins of adult disease, from 2003 developmental origins of health and disease (DOHaD), has stimulated significant interest in and an efflorescence of research on the long-term effects of the intrauterine environment. From the start, this field has been interdisciplinary, using experimental animal, clinical and epidemiological tools. As the influence of DOHaD on public health and policy expanded, it has drawn criticism for reducing the complex social and physical world of early life to women’s reproductive (...) bodies as drivers of intergenerational ills. This paper explains this narrowing of focus in terms of a formative and consequential exchange between David Barker, the British epidemiologist whose work is credited with establishing the field, and the discipline of fetal physiology. We suggest that fetal physiologists were a crucial constituency of support for Barker’s hypothesis about early life origins of disease. Their collaborations with Barker helped secure and sustain the theory amid considerable controversy. The trajectory of DOHaD and its focus on the maternal body can be understood, we argue, as a consequence of this alliance, which brought together two distinct conceptualizations of the intrauterine environment, one from epidemiology and the other from fetal physiology. Along the way, we trace the histories of these conceptualizations, both of which were products of mid-to-late twentieth century British science, and show how Barker’s early emphasis on social and economic conditions was superseded by a narrower focus on physiological mechanisms acting upon the autonomous fetus. (shrink)

The Standard View of personal identity says that someone who exists now can exist at another time only if there is continuity of her mental contents or capacities. But no person is psychologically continuous with a fetus, for a fetus, at least early in its career, has no mental features at all. So the Standard View entails that no person was ever a fetus--contrary to the popular assumption that an unthinking fetus is a potential person. It (...) is also mysterious what does ordinarily happen to a human fetus, if it does not come to be a person. Although an extremely complex variant of the Standard View may allow one to persist without psychological continuity before one becomes a person but not afterwards, a far simpler solution is to accept a radically non-psychological account of our identity. (shrink)

A central claim in abortion ethics is what might be called the Harm Claim – the claim that abortion harms the fetus. In this article, we put forward a simple and straightforward reason to reject the Harm Claim. Rather than invoking controversial assumptions about personal identity, or some nonstandard account of harm, as many other critics of the Harm Claim have done, we suggest that the aborted fetus cannot be harmed for the simple reason that it does not (...) occupy any well-being level. (shrink)

The Standard View of personal identity says that someone who exists now can exist at another time only if there is continuity of her mental contents or capacities. But no person is psychologically continuous with a fetus, for a fetus, at least early in its career. has no mental features at all. So the Standard View entails that no person was ever a fetus---contrary to the popular assumption that an unthinking fetus is a potential person. It (...) is also mysterious what does ordinarily happen to a human fetus, if it does not come to be a person. Although an extremely complex variant of the Standard View may allow one to persist without psychological continuity before one becomes a person but not afterwards, a far simpler solution is to accept a radically non-psychological account of our identity. (shrink)

The traditional approach to the abortion debate revolves around numerous issues, such as whether the fetus is a person, whether the fetus has rights, and more. Don Marquis suggests that this traditional approach leads to a standoff and that the abortion debate “requires a different strategy.” Hence his “future of value” strategy, which is summarized as follows: (1) A normal fetus has a future of value. (2) Depriving a normal fetus of a future of value imposes (...) a misfortune on it. (3) Imposing a misfortune on a normal fetus is prima facie wrong. (4) Therefore, depriving a normal fetus of a future of value is prima facie wrong. (5) Killing a normal fetus deprives it of a future of value. (6) Therefore, killing a normal fetus is prima facie wrong. In this paper, I argue that Marquis’s strategy is not different since it involves the concept of person—a concept deeply rooted in the traditional approach. Specifically, I argue that futures are valuable insofar as they are not only dominated by goods of consciousness, but are experienced by psychologically continuous persons. Moreover, I argue that his strategy is not sound since premise (1) is false. Specifically, I argue that a normal fetus, at least during the first trimester, is not a person. Thus, during that stage of development it is not capable of experiencing its future as a psychologically continuous person and, hence, it does not have a future of value. (shrink)

A central claim in abortion ethics is what might be called the Harm Claim – the claim that abortion harms the fetus. In this article, we put forward a simple and straightforward reason to reject the Harm Claim. Rather than invoking controversial assumptions about personal identity, or some nonstandard account of harm, as many other critics of the Harm Claim have done, we suggest that the aborted fetus cannot be harmed for the simple reason that it does not (...) occupy any well-being level. (shrink)

The Problem of Biological Individuality is the problem of how to count organisms. Whilst counting organisms may seem easy, the biological world is full of difficult cases such as colonial siphonophores and aspen tree groves. One of the main solutions to the Problem of Biological Individuality is the Physiological Approach. Drawing on an argument made by Eric Olson in the personal identity debate, I argue that the Physiological Approach faces a metaphysical problem - the ‘Foetus Problem’. This paper illustrates how (...) metaphysics can contribute to debates about organisms in the philosophy of biology. (shrink)

This paper defends and develops Elizabeth Harman’s Actual Future Principle with a concept called Schrödinger’s Fetus. I argue that all early fetuses are Schrödinger’s Fetuses: those early fetuses that survive and become conscious beings have full moral status already as early fetuses, but those fetuses that die as early fetuses lack moral status. With Schrödinger’s Fetus, it becomes possible to accept two widely held but contradictory intuitions to be true, and to avoid certain reductiones ad absurdum that pro-life (...) and pro-choice positions face. It also gives a simple solution to the problem of prenatal harm. (shrink)

Judith Jarvis Thomson famously argued that abortion is permissible even if we accept that a fetus qualifies as a person and possesses a right to life. The current paper presents two arguments that undermine Thomson’s position. First, the paper sketches a contractarian argument that explores Thomson’s violinist thought experiment from behind a veil of ignorance, which suggests that if we had an equal likelihood of being an unwanted fetus and a pregnant woman, it would be rational for us (...) to oppose abortion. Second, the paper discusses the hypothetical self-aborting fetus, a thought experiment that reverses the dependence relationship between a woman and a fetus. It is argued that in this scenario, where fetuses have agency of their own, Thomson’s position would counterintuitively prohibit a woman from temporarily curtailing the freedom of her fetus even to save her own life. (shrink)

Who has more rights-the mother or the fetus? Interdisciplinary in scope and character, this latest volume of Humana's classic series, Biomedical Ethics Reviews, focuses on the complex moral and legal problems involving human fetal life. Each article in Bioethics and the Fetus provides an up-to-date review of the literature and advances bioethical discussion in its field. The authors have avoided much of the technical jargon of philosophy and medicine in order to speak directly to a broad and general (...) readership. Topics include: • maternal-fetal conflict • the disposition of aborted fetuses • frozen embryos • creating children to save sibling's lives • fetal tissue transplantation • moral implications of fetal brain integration • the embryo as patient • prenatal diagnosis. Probing deeply into these thorny issues, Bioethics and the Fetus offers thought-provoking reading-and paves the ground for new insight-for a host of healthcare and other professionals, as well as concerned laypersons. (shrink)

Joona Räsänen has proposed a concept he calls Schrödinger’s Fetus as a solution to reconciling what he believes are two widely held but contradictory intuitions. I show that Elizabeth Harman’s Actual Future Principle, upon which Schrödinger’s Fetus is based, uses a more convincing account of personhood. I also argue that both Räsänen and Harman, by embracing animalism, weaken their arguments by allowing Don Marquis’ ‘future like ours’ argument for the immorality of abortion into the frame.

Bypassing the question of when "human" life begins, the author seeks to determine the moral status of the fetus directly by means of a rational theory of rights. He argues that all agents with an operative rational and moral capacity are entitled to full equal rights, while the rights of those lacking these capacities are conferred by rational, moral agents. After reviewing the general considerations that would lead rational agents to confer rights, the author concludes that these agents would (...) probably not choose to restrict their liberty of abortion by conferring substantial rights on the fetus. (shrink)

The Problem of Biological Individuality is the problem of how to count organisms. Whilst counting organisms may seem easy, the biological world is full of difficult cases such as colonial siphonophores and aspen tree groves. One of the main solutions to the Problem of Biological Individuality is the Physiological Approach. Drawing on an argument made by Eric Olson in the personal identity debate, I argue that the Physiological Approach faces a metaphysical problem - the ‘Foetus Problem’. This paper illustrates how (...) metaphysics can contribute to debates about organisms in the philosophy of biology. (shrink)

A number of developments in the medical field have changed the debate about the ethics of abortion. These developments include: advances in fetal physiology, the increase in neonatal intensive care and the survival rates of premature infants. This paper discusses the idea of selective termination and the effects that these decisions have on disabled people of today. It presents a critique of the counselling services that are provided for the parents of a disabled fetus and discusses how this is (...) viewed from a social perspective. The article ends with an argument that the mother deserves to be autonomous in the decision of abortion. The easiest and most fair way to develop her autonomy is to consider the relationship between a professional and a mother as an expert–expert relationship. Here both parties are considered experts in diagnostic information, treatment options, possibilities, and their history, family roots, philosophy and way of life, respectively. (shrink)

          First an outline of the argument Assume that I once was a fetus. Who will deny this —surely a fetus was what I once was? Yet, though it is hard to deny, much of this paper will be work to bolster up this portion of the argument. For now assume this. But now if the right-to-life (understood as the right not to be deprived of life by human decision (...) unless one has deserved such deprivation through a crime that one has been.. (shrink)

Hospital ehtics committees are often consulted when cmopeting patient interests blur an otherwise clear course of medical treatment. Nowhere is the potential for competing interests greater than in the field of abosterics, wherer obstetricians have traditionally viewed themselves as having two patients: the pregnant woman and the fetus.

Recently, a number of philosophers have argued that, despite appearances, the success of Don Marquis's well-known future-like-ours argument against abortion does not turn, in an important way, on the metaphysics of identity. I argue that this is false. The success of Marquis's argument turns on precisely two issues: first, whether it is prima facie seriously wrong to deprive something of a future like ours; second, whether, in a counterfactual circumstance in which an abortion does not occur, the foetus is numerically (...) identical with something that, later on, experiences a life like ours. Since the former claim is plausible (albeit disputable), the success of Marquis's argument does turn on the metaphysics of identity in an important way. Before defending a positive argument for this position, I consider what I take to be the most promising way of challenging it. This involves a recent objection to Marquis by Tim Burkhardt (2021). Burkhardt claims that his objection floats free of the metaphysics of identity. I argue that it fails to do so, and that in fact it fails outright. I end by considering the relationship between my arguments and the question of what matters in survival. (shrink)

I reviewed Pope Francis’s Address as one acutely aware of the extremely murky psycho-political cloud surrounding womb-determinism in the United States, and coming to it without any religion-based predisposition on the issue.I made note that Pope Francis’s main point is not proscriptive. He gives a low profile to any dogmatic definition of the sanctity of life. His tone is humane, not doctrinal.The Pope proposes that the fetus, like the child who follows, is basically a messenger, communicating from the womb (...) and creating the universe that will define the mother, the family, and the wider community. This point is not moral—he calls it “pre-religious”—but semiotic, concerned with the nature and structure of how we... (shrink)

Pro-life and pro-choice advocates battle for rational dominance in abortion debates. Yet, public polling (and general legal opinion) demonstrates the public’s preference for the middle ground: that abortions are acceptable in certain circumstances and during early pregnancy. Implicit in this, are two contradictory intuitions: (1) that we were all early fetuses, and (2) abortion kills no one. To hold these positions together, Harman and Räsänen have argued for the Actual Future Principle (AFP) which distinguishes between fetuses that will develop into (...) persons and those that will never develop into persons. However intellectually ingenious their solutions are, they fail to account for a third intuition: that the death of a wanted fetus – e.g. through termination or miscarriage – is of moral significance. Not only is this practically important, but it is also supported by public opinion. The authors of this paper argue that relational ontology can modify the AFP to better account for all three intuitions. Furthermore, it further emphasizes the pivotal role of the pregnant person who relates to their own fetus in either personal or impersonal ways. Addressing the fundamental challenges of relational ontology, the authors defend the position that human personal identity is ultimately relational. (shrink)

We examine pregnant women's experiences with routinised obstetric ultrasound as entailed in their antenatal care during planned pregnancies. This paper highlights the ambiguity of ultrasound technology in the constitution of maternal–foetal connections. Our analysis focusses on Australian women's experiences of the ontological, aesthetic and epistemological ambiguities afforded by ultrasound. We argue that these ambiguities offer possibilities for connecting to the foetus in ways that maintain a kind of unknowability; they afford an openness and ethical responsiveness irrespective of the future of (...) the foetus. This suggests that elucidating women's experience has implications for theorising ethics across maternal–foetal relations and, more specifically, for the ‘moral pioneering’ (Rapp, 2000) that reproductive technologies can demand of women. Moral pioneering cannot be reduced to moments or processes of decision-making; it must allow for greater recognition of the affective commitments entailed in and incited by ultrasound. Furthermore, focussing on experiences of the ambiguity of ultrasound allows for understanding the ways in which affectivity circulates across domains commonly understood as medical or social, public or private. In doing so, it contributes to undermining a series of tensions that currently shape feminist analysis of obstetric ultrasound, often at the expense of the experience of women. (shrink)

Are fetuses, at any stage of their development, capable of feeling pain? In his paper, ‘Locating the Beginnings of Pain’, Stuart Derbyshire argues that they are not. We argue that he reaches this conclusion by way of conceptual confusion, a misreading of the available scientific data and the inclusion of irrelevant data. Despite his assertion to the contrary, the work of most scientists in the area supports the conclusion that fetuses can feel pain. At the outset we examine the concept (...) of pain and distinguish it from the allied concept of nociception, with which it is sometimes confused. With the relevant conceptual framework in place, we elucidate the problem of determining when, in its development, a human becomes capable of feeling pain. We then examine the available data showing how, on balance, it tends more to support than undermine the claim that fetuses of around 28 to 30 weeks' gestation are capable of feeling pain. (shrink)

The fetal human possesses an active central nervous system from at least the eighth week of development. Until mid-gestation the most significant center of activity is the brainstem. By the end of the first trimester, it appears that the brainstem could be acting as a rudimentary modulator of sensory information and motor activity. What importance ought to be attached to such regulatory activity is uncertain. Some argue that it represents a level of integrated activity sufficient to bolster an argument for (...) conferring some measure of standing at this point. Our thinking about sentience is not advanced a great deal, as we as yet have no good way of talking about it at the brainstem level. As for the neocortex, available evidence indicates that it does not become a functional part of the neuraxis until at least mid-gestation. It is not until then that the thalamus – the major gateway for sensory input to the cerebrum – makes its first afferent contacts with the neocortex. Keywords: neuromaturation, fetal behavior, fetal brainstem CiteULike Connotea Del.icio.us What's this? (shrink)