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Technological advances in medicine have changed the landscape of fetal medicine considerably. Growing knowledge in fetal physiology, ultrasound, antenatal screening and an emphasis on preventive medicine promotes the detection of a wide range of abnormalities leaving both parents and obstetricians with difficult choices at various stages during pregnancy. Early terminations are ethically controversial. However, late terminations (>20 weeks gestation) and feticide (including post-viable fetuses) have advanced the debate on the ethics of abortion. Poignant ethical questions surround the status of the fetus as opposed to that of the newborn.While most regulations regard severe fetal abnormalities as being incompatible with life and having the potential to cause severe pain and suffering after birth, slippery-slope arguments are raised when feticide is performed for abnormalities like cleft lip and palate. Respecting the autonomy of the mother who may request a termination late in her pregnancy raises enormous ethical conflict for the treating obstetrician who must balance this request against the principle of non-malfeasance (doing no harm) inherent in killing a viable fetus. There is a clear moral distinction between actively killing an abnormal viable fetus and allowing an abnormal newborn to die after birth. This distinction may be lacking in policy-making in countries with a permissive feticide policy and a restrictive neonatal policy in respect of non-treatment. Furthermore, where feticide is
concerned, do obstetricians have a right of conscientious objection globally? At a more complex level, destruction of a viable fetus with significant abnormalities raises concerns of eugenics. Is feticide and late termination of pregnancy discriminatory towards people with disabilities and a veiled attempt to create a genetically pure population?
This paper explores the ethical conflict and legal inconsistency in feticide and late termination of pregnancy at a global level and argues for a universal policy based on fetal status and acknowledgment of the moral distinction between killing and letting die.
Keywords: Ethics; Feticide; Late termination of pregnancy
O & G Forum Vol. 18 (3) 2008: pp. 93-95