Victimhood Without Personhood

Upon prenatal diagnosis of congenital malformations, termination of pregnancy (TOP) may be an option, sometimes at a gestational age when the fetus is already viable (late TOP). We aimed to study attitudes towards late TOP of all tertiary healthcare professionals involved in late TOP practice. A mail survey was conducted among all physicians and paramedical professionals involved in late TOP decision-making in all eight centers with a Neonatal Intensive Care Unit in Flanders, Belgium (N=117). The questionnaire contained general and case-based attitude items. Response rate was 79%. Respondents were either physicians (51.1%) or paramedical professionals (49.9%). The composition of professionals involved in late TOP decision-making was heterogeneous between the eight centers. Late TOP was highly accepted in both lethal fetal conditions (100%) and serious (but not lethal) fetal conditions (95.6%). Where the fetus is healthy, 19.8% of respondents agreed with late TOP for maternal psychological problems and fewer respondents (13.2%) agreed with late TOP in the case of maternal socio-economic problems (P=.002). Physicians more often preferred feticide over neonatal palliative care in the case of non-lethal fetal conditions compared with paramedical professionals (68.1% vs 53.2%, P=.013). Almost nine out of ten respondents (89.1%) agreed that in the event of a serious (non-lethal) neonatal condition, administering drugs with the explicit intention to end neonatal life was acceptable. Behavioral intentions indicate that even in situations with an unclear diagnosis and unpredictable prognosis, 85.6% of professionals would still consider late TOP. Healthcare professionals practicing late TOP in Flanders, Belgium have a high degree of tolerance towards late TOP, irrespective of sociodemographic factors, and are demanding legislative change regarding active life-ending in the fetal and neonatal periods. Further research should explore the correlation of attitudes to late TOP with actual medical decisions taken in daily clinical practice.

ObjectiveTo study the implementation value of abdominal B-ultrasound combined with cervical cerclage in the prevention and treatment of recurrent late abortion.MethodsFrom October 2020 to December 2023, 196 pregnant patients who had a history of late abortions at our institution were chosen. They were divided into groups based on the treatments used. In the observational team, 98 instances received abdominal B-ultrasound along with cervical cerclage, while 98 instances in the controlling team underwent traditional conservative treatment. Vaginal flora, inflammatory factor levels, labor outcomes, uterine artery parameters, and adverse effects were observed in both groups of pregnant women.ResultsComparing the detection of vaginal flora between the two groups, the difference was not statistically significant (P > 0.05); the detection values of WBC, neutrophil percentage and neutrophil absolute value in the observation group were lower than those in the control group (P < 0.05). The recurrent late abortion rate (4.08%) and premature delivery rate (16.33%) were lower than those of the control group, and the full-term delivery rate (79.59%) and total fetal survival rate (93.88%) were higher than those of the control group, and the difference was statistically significant (P < 0.05). The resistance index (RI) and pulsatility index (PI) of pregnant women with abortion were higher than those of live birth pregnant women. The RI and PI of group A (pregnant women with recurrent late abortion) at 7, 12, 24 and 32 weeks of gestation were also higher than those of group B (pregnant women without recurrent late abortion), and the difference was statistically significant (P < 0.05). At 7 weeks of gestation, there was no statistical difference between the observation and control groups in terms of RI and PI (P > 0.05)0.12 By 32 weeks of gestation, the RI and PI were lower in the observation group than in the control group (P < 0.05)0.13 In the observation group, the RI and PI were lower than in the control group (P < 0.05). The incidence of gestational hypertension, gestational diabetes mellitus, and eclampsia were significantly lower in the observation group compared to the control group (P < 0.05).ConclusionAbdominal ultrasound combined with cervical cerclage reduces the risk of miscarriage by improving the hemodynamic status of the uterus and placenta, and also optimizes the pregnancy environment by reducing the inflammatory response in the uterine cavity, which has important clinical applications in the prevention and treatment of late recurrent spontaneous abortion.

Early Pregnancy Losses: Multiple Meanings and Moral Considerations

This article considers the legal issues surrounding induced late abortion in cases when severe medical, therapeutic or ethical reasons have not been in dispute. Generally discussing the essential question about abortion today, it means not anymore legality of abortion but, in the first place, safety of abortion. From the aspect of woman health the most important aim is to detect and avoid possible risks of medical intervention, such as late abortion present. This is the matter of medical law context and also the matter of the woman's reproductive rights, here observed through legislation and court practice. The gynecologist has an obligation to obtain the informed consent of each patient. Information's should be presented in reasonably understandable terms and include alternative modes of treatment, objectives, risks, benefits, possible complications, and anticipated results of such treatment. Pregnant woman should receive supportive counseling before and particularly after the procedure. The method chosen for all terminations should ensure that the fetus is born dead. This should be undertaken by an appropriately trained practitioner. Reform in abortion law, making it legally accessible to woman, is not necessarily the product of a belief in woman's rights, but can be a means of bringing the practice of abortion back under better control. Counseling and good medical practice in performing late abortion are the instruments to drive this point even further home. It does not undermine the woman who wants to make a positive decision about her life and its purpose is not to produce feelings of insecurity and guilt. It concludes that existing law should not be changed but that clear rules should be devised and board created to review late term abortion. In Serbia, this leads to creation and set up guidelines for reconciling medical justification for late abortion with existing law, especially with solutions which brings comparative law. .

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

The introduction of prenatal screening for all pregnant women in Denmark in 2004 has lead to an increase in the number of late terminations of pregnancy after the 12th week of pregnancy. Midwives' experiences with late termination of pregnancy (TOP) are still poorly described in the scientific literature. To explore Danish midwives' experiences with and attitudes towards late TOP. Focus was on how midwives perceive their own role in late TOP, and how their professional identity is influenced by working with late TOP in a time where prenatal screening is rapidly developing. A qualitative study consisting of ten individual interviews with Danish midwives, all of whom had taken part in late TOP. Current practice of late TOP resembles the practice of normal deliveries and is influenced by a growing personalisation of the aborted foetus. The midwives strongly supported women's legal right to choose TOP and considerations about the foetus' right to live were suppressed. Midwives experienced a dilemma when faced with aborted foetuses that looked like newborns and when aborted foetuses showed signs of life after a termination. Furthermore, they were critical of how physicians counsel women/couples after prenatal diagnosis. The midwives' practice in relation to late TOP was characterised by an acknowledgement of the growing ethical status of the foetus and the emotional reactions of the women/couples going through late TOP. Other professions as well as structural factors at the hospital highly influenced the midwives' ability to organize their work with late terminations. There is a need for more thorough investigation of how to secure the best possible working conditions for midwives, and how to optimise the care for women/couples going through late TOP.

The task of this paper is to examine the integration of obstetric ultrasound images in moral and legal debates on the status of the human fetus, particularly through the framework of the constitution of fetal personhood. I focus on the questions about the moral and legal significance of prenatal life and birth as construed through recent shifts in law toward so-called ‘fetal homicide’ laws. Throughout, I argue that the moral status of the fetus has a performative dimension, realised in the operation of obstetric ultrasound and the interpolation of the fetus as a person that it effects. As I show, in regard to the constitution of the fetus as person, obstetric ultrasound operates as a technological means of mediation between the human body and the concept of the person.

One of the most challenging scenarios in obstetric care occurs when a pregnant patient refuses recommended medical treatment that aims to support her well-being, her fetus's well-being, or both. In such circumstances, the obstetrician-gynecologist's ethical obligation to safeguard the pregnant woman's autonomy may conflict with the ethical desire to optimize the health of the fetus. Forced compliance-the alternative to respecting a patient's refusal of treatment-raises profoundly important issues about patient rights, respect for autonomy, violations of bodily integrity, power differentials, and gender equality. The purpose of this document is to provide obstetrician-gynecologists with an ethical approach to addressing a pregnant woman's decision to refuse recommended medical treatment that recognizes the centrality of the pregnant woman's decisional authority and the interconnection between the pregnant woman and the fetus.

Miscarriage of pregnancy is widely experienced and seldom discussed. Because of the surpassing silence on the subject, experiences of miscarriage may be misunderstood, difficult to articulate, and isolating, and attitudes toward miscarriage may be under-informed. Women are more likely to be offered cultural information on what to expect when we are expecting, than we are to be offered preparation for, or recognition of, the unexpected. Philosophers can, and should, contribute to changing that by promoting discourse on miscarriage as an experience which is meaningful, and significant to self-understanding and social awareness, and by providing a contextual realm in which related discussions of pregnancy, fertility loss, and fetal death could take place. The implications of reflections on the phenomenon of miscarriage for many lines of inquiry turn out to be multifold. To date, unfortunately, philosophers have not been central participants in theorizing about miscarriage, pregnancy loss, or fetal death outside of the confines of abortion debates.1 We ought to be concerned about the risks of furthering the social and academic silence surrounding phenomena that so many have experienced, and that raise important questions regarding grief and loss, the social construction of pregnancy, technological developments, social recognition, and, to put it grandly, the nature of human life. As our contributors observe, one reason at least for the silence on miscarriage is obvious: addressing and conceptualizing the loss that is central to some (and not all) experiences of miscarriage may risk undermining some central principles of reproductive freedom. As feminist philosophers, we are certainly sympathetic to such concerns. We suggest that the riskiness of theorizing about miscarriage, and its implications for applied philosophical arguments with respect to abortion, seem to us to be compelling reasons why this issue is especially important to offer. The practice of philosophical investigation includes the social practices of cooperatively facing our reasons for ignoring some topics while devoting attention to related issues. Existing accounts of meaning in reproductive contexts—especially those put forward in debates concerning abortion—tend to focus on the (moral) status of the fetus. This is true even of relational accounts aimed at promoting reproductive autonomy by highlighting the ways in which the fetus is inseparable from the woman who carries it. It will probably not come as a surprise that we hope this issue on miscarriage, pregnancy loss, and fetal death accomplishes a shift this conversation, in the direction of pushing past embryo-centric value judgments. In part this is because, to put it bluntly, the miscarried embryo is not the one who has to live with the experience. The essays in this special issue are a significant addition to the scarce literature on miscarriage and fetal death. Contributions are from specialists in continental and analytical philosophy, feminism, bioethics, theoretical and applied ethics, social and political philosophy, social epistemology and philosophy of language, narrative, aesthetics, popular culture, and gender studies. As guest editors, we sought to offer a variety of approaches to the topic, to further the understanding of miscarriage and fetal death as important to many areas of philosophy, especially social philosophy. We suggest that the unchosenness and invisibility of miscarriage are central to its seeming irrelevance to social identities and social norms of testimony, recognition, and ascription of significance to experiences. The first several contributions to this volume focus on the phenomenon of miscarriage and its meanings. In “‘The Event That Was Nothing’: Miscarriage as a Liminal Event,” Alison Reiheld argues that miscarriage is poorly understood and that people find it difficult to make sense of the experience of miscarriage for the reason that it is a liminal event—an event suspended in a space between socially recognized states. Reiheld identifies four distinct, but related, dimensions along which miscarriage is liminal: parenthood, procreation, death, and abortion. In relation to parenthood, miscarriage halts the transition from not being a parent to being a parent to the child that would have been born. In relation to procreation as a result of a specific pregnancy, miscarriage lies between having procreated and having not procreated. In relation to death, it is not clear whether miscarriage involves the death of someone or the loss of (potential) life given the lack of social agreement about the status of embryos and fetuses. In relation to abortion, miscarriage lies in the space between the social categories of induced abortion and pregnancy. Reiheld argues that, as a result of its liminality, miscarriage has been enrolled in social and moral debates that are not really about miscarriage at all. These include debates about the permissibility of abortion and debates about control over pregnancy. By considering particular laws bearing on miscarriage, Reiheld points to some of the dangers resulting from our failure to separate miscarriage from the states between which it is suspended. Reiheld's hope is that a better understanding of miscarriage's liminality will help us respond in better ways to women who experience miscarriage and avoid enrolling their experiences in debates that really have little to do with miscarriage. In “Early Pregnancy Losses: Multiple Meanings and Moral Considerations,” Amy Mullin draws on literature from a variety of disciplines to highlight some of the complex and variable features of the ethical terrain related to pregnancy loss. She then considers, specifically, the moral significance of early pregnancy loss—that is, pregnancy loss that occurs before the fetus is sentient and before the fetus is able to survive outside of the womb. Mullin points to problems with arguments that tie the moral status of the fetus to the question of whether the fetus is a person. These include the argument, defended by many feminist scholars, that the moral status of a fetus depends on the extent to which other people, and especially pregnant women, construct their fetuses as persons. Mullin proposes another way of understanding the moral significance of early pregnancy loss. Specifically, she postulates that the loss of embryos or early fetuses can be morally considerable for the reason that embryos and early fetuses have the potential to survive until infancy and to become members of the moral community (a potential resting on both the features of the fetus itself and the plans of the pregnant woman). If we accept this postulate, we are able to understand miscarriage as a loss of a being that is morally considerable without presupposing that every person will respond to pregnancy loss in the same way and without abandoning respect for reproductive autonomy. In “Miscarriage and Intercorporeality,” Ann J. Cahill develops a philosophical account of pregnancy that allows the possibility of recognizing the suffering of persons who experience miscarriage without undermining reproductive rights. Cahill resists the relational model of pregnancy defended by many feminist scholars and invoked in the accounts of miscarriage defended by Carolyn McLeod and Kate Parsons.2 On a relational model, pregnancy is conceived of as a severable relation between two distinct individuals where the pregnant woman can attach moral and emotional significance to the relationship (and indeed to the fetus) as though she were somehow outside of the relationship, whereas the fetus cannot. While Cahill acknowledges that a relational model of pregnancy has much to recommend it, she argues that this model is problematic in so far as it rests on an individualism that precludes recognition of the ways in which the lived, embodied experience of pregnancy is transformative of the pregnant woman's subjectivity. Cahill draws on Rosalyn Diprose's notion of corporeal generosity—the prereflective openness to otherness and being given to others that constitutes social relations—to account for pregnancy and miscarriage in a manner that reflects the intersubjectivity, rather than mere relationality, of these phenomena.3 Cahill holds it to be an ontological fact that identities are constructed only through interaction with other embodied beings such that the identity of any subject is tied to and implicated in the identity of other bodies and identities. She argues that the identity being constructed by the pregnant person as a pregnant person (as an expectant parent, for instance) is inescapably intertwined with the existence of the fetus. Miscarriage is, on this account, disorienting and gives rise to many, often conflicting, emotions in so far as it ends the transformative experience of pregnancy—often with painful and sometimes long-lasting physical effects—and calls into question the identity under construction. In her contribution, “Miscarriage and Person-Denying,” Lindsey Porter considers one way in which reflecting on miscarriage and people's reactions to miscarriage can inform debates about the moral status of abortion. Specifically, she argues against person-denying arguments for the moral permissibility of abortion—arguments aimed at establishing the permissibility of abortion on the grounds that the fetus is not a person and, thus, lacks moral status. Porter observes that grief is a common response to miscarriage and suggests that grief following miscarriage is evidence that some people experience miscarriage as the loss of a loved one. She draws on Martha Nussbaum's account of grief to argue that grief following miscarriage presupposes that the fetus is something that should be given moral consideration—something with moral status.4 Porter argues that, if the person-denying argument works, it works only in the “strong form” in which it is understood that the fetus is entirely outside of the sphere of moral concern. Thus, unless we dismiss people who grieve following miscarriage as being mistaken about the significance of their loss, something Porter is unwilling to do, we must reject person-denying arguments. Along with other authors contributing to this volume, Porter is very clear that her argument is not meant to undermine reproductive autonomy. Even if we reject person-denying arguments, the permissibility of abortion might be defended on other grounds. The next several contributions focus on the ways in which experiences of miscarriage are shaped by social scripts and narrative-sharing spaces (or lack of same). While several authors contributing to this volume note with dismay the social silence surrounding the phenomenon of pregnancy loss, Hilde Lindemann's “Miscarriage and the Stories We Live By” reminds us of the relevance of narrative even with regard to things rarely spoken of. She considers that the stories by which people in English-speaking societies identify a woman who is pregnant as an “expectant mother” commonly look forward to, and converge on, the birth of the child. As such, it is easy to make sense of who a woman is when she is pregnant and it is easy to respond well to what the pregnant woman does to express who she is. In contrast, it is often difficult to know how to respond well to a woman who has miscarried. Lindemann argues that we do not lack stories by which to make sense of miscarriage. Rather, she contends that the difficulty lies in determining which stories help us respond well to people who experience a miscarriage. Lindemann suggests one condition: the stories we construct must reflect that miscarriage involves the loss of something valuable to the pregnant woman, to the fetus, or both. Recognizing that pregnancy is not purposeful in every respect, Lindemann argues for an account of pregnancy that emphasizes the agency of the pregnant woman—the creative activity that includes transforming biological processes in purposeful and deliberate ways by caring for, valuing, and giving meaning to (or otherwise coming to terms with) the natural processes of pregnancy in addition to the social activity of creating the stories that constitute the identity of the ‘child’ and the identity of the pregnant woman as an expectant mother. Lindemann also emphasizes the need to listen to the stories the woman is telling—her stories may or may not represent her as having suffered a loss. Whatever story we tell to make sense of miscarriage must represent the loss to the fetus. In “The Value of Pregnancy and the Meaning of Pregnancy Loss,” Byron Stoyles considers the meaning and value of pregnancy to conceptualize pregnancy loss and reactions to pregnancy loss. Stoyles begins by reflecting on the different ways in which philosophers engaged in debates about the moral and legal status of abortion conceptualize the meaning of pregnancy. He argues that most of the arguments found in the literature about abortion (including most feminist arguments) are fetal-centric in the sense that they focus on the status of the fetus to such an extent that the value and meaning of pregnancy as something involving persons other than the fetus is mostly ignored. Stoyles then builds on Hilde Lindemann's account of the value and meaning of pregnancy by considering how value in pregnancy can derive from both the activity Lindemann calls “calling the fetus into personhood” (an idea she explains in her contribution to this volume) and what he calls the activity of creating an identity as a parent. Stoyles argues that the recognition of these related activities allow us to make sense of common—albeit diverse and sometimes conflicting—reactions to pregnancy loss including confusion about the identity of the would-be parents and the fetus. In “Making Sense of Miscarriage Online,” Sarah Hardy and Rebecca Kukla explore ways in which women who have experienced miscarriage give narrative shape to their experiences online. Hardy and Kukla begin by noting ways in which it is difficult to make sense of miscarriage against the backdrop of medical institutions and practices in so far as miscarriage is treated as medically significant (as most matters related to pregnancy are), but also as something that happens mostly outside of the medical context. Using examples from Facebook, discussion boards, and blogs, Hardy and Kukla consider how women use online fora to articulate the experience of miscarriage and to shape their narrative identity outside of the medical context. They also consider ways in which online fora provide opportunities for other people to give uptake to women's responses to miscarriage by posting comments and stories affirming women's responses to miscarriage as meaningful. In their contribution, Hardy and Kukla point to a number of ways in which the functional structure of different online spaces influence the kind and quantity of content posted. Facebook, for example, allows each author extensive control over the content of her own page whereas discussion boards are inherently more conversational. Despite such differences, Hardy and Kukla contend that the internet provides important social tools for creating new kinds of collaborative interaction. Engaging online, women can maintain their anonymity, create multiple (even incompatible) narrative threads simultaneously, and otherwise make sense of the experience of miscarriage in a more or less collaborative way. The last two contributions focus more explicitly on ethical questions surrounding fetal death. In “Rethinking Abortion, Ectogenesis, and Fetal Death,” Christine Overall proposes a revised understanding of abortion and argues that pregnant women are entitled to choose abortion as this is understood to include both ending the life of the fetus in utero and the evacuation of the uterus. This view is a departure from Overall's earlier view that pregnant women are entitled to choose uterine evacuation but not to end the life of the fetus if it could survive by means of ectogenesis (gestation within an artificial uterus).5 Overall outlines how she has changed her view after considering objections to her earlier work. Specifically, the view Overall defends in her contribution to this volume is aimed at rethinking abortion in a way that is consistent with pregnant women's bodily autonomy and women's right to not reproduce. The former reflects Overall's view that the pregnant woman's relationship to the fetus determines what can be done for or to it (on Overall's account, the fetus has no independent moral status until it emerges from the woman's body) and respects that women's bodily autonomy should include being entitled to determine what happens not only to one's body but also to one's body parts and the products of one's body (including the fetus). The latter respects that reproductive autonomy should reflect a right not to reproduce and the reality that a woman might want there to be no genetic offspring resulting from the pregnancy that is ended. Though Overall argues for the right for the pregnant woman to kill the fetus in utero, she opposes “after-birth abortion” for the reason that, on her view, an infant does not have the same moral status as a fetus. Since an infant is no longer in the same relationship to the pregnant woman as a fetus, a woman's entitlement to end the life of the fetus ends once it is removed from her body. Overall goes on to consider moral questions and potential problems related to the possibility of ectogenesis which she no longer regards as part of the solution to debates related to abortion. The collection closes with Sarah Clark Miller's “The Moral Meanings of Miscarriage,” in which she attends to the range of ethical challenges presented by complex and varied responses to miscarriage. Miller articulates the urgency of the need for a “perinatal ethics,” that is, not just a prenatal bioethics which tends to be the focus of clinical obstetrics literature, but a more robust ethical approach that addresses the moral issues that arise before, during, and after pregnancy, appreciative of the changes in a woman's identity over the course of the arc of miscarriage experience. Miller contends that miscarriage exceeds the standard categories of ethical analysis, involving the blending of moral agent and moral patient in the same individual, the presence of distinctive reactive attitudes along with social and political denial of recognition that an event occurred at all, the moral standing of fetal life, and the moral self-understanding of women who suffer pregnancy loss. Miller concludes that, absent a better formulation of ethics regarding miscarriage, we are in danger of neglecting the moral considerability of women when we fail to attend to their moral emotions regarding their pregnancy losses. Even these brief synopses indicate some fruitful and productive overlaps among the diverse articles that comprise this volume. There is controversy, for example, over the centrality of loss with regard to miscarriage; Cahill rejects the narrative of loss, while Lindemann argues that loss accrues to the fetus as well. The collected articles draw important connections between miscarriage and elective abortion, two phenomena that in common discourse are viewed as entirely distinct. To the contrary, our authors (especially Overall, Stoyles, and Porter) articulate important ways in which ways of thinking about abortion can affect our understanding of miscarriage, and vice versa. Mullin and Miller argue that paying philosophical attention to miscarriage should and must transform our understanding of the ethics of pregnancy and reproductive autonomy, and while Reiheld provides the most detailed account of the liminality of miscarriage, several other articles address its uncanny nature, the slippery in-betweenness that may contribute to the social and intellectual silence that surrounds the topic. Finally, almost every article in the collection mentions that silence, but Kukla and Hardy describe the way that cyberspace not only provides an opportunity for the sharing of narratives, but in fact shapes those narratives in significant ways. Yet unexplored questions remain. Reiheld's contribution articulates some of the ways that the liminality of miscarriage intersects with laws regarding pregnancy to increase the vulnerability of pregnant bodies; yet even more attention is needed to the various ways in which miscarriage has been criminalized, leading to the incarceration of women who have experienced pregnancy loss.6 There is more to be said too about the experience of the partners (of all sexes) of pregnant persons who have experienced miscarriage. What philosophical meanings can be found in an embodied experience that happens to another that has potentially transformative effects on the partner's own (perhaps embodied) subjectivity? Finally, the intriguing parallels between miscarriage and elective abortion need further exploration. How might recognizing the similarities between these phenomena (without ignoring their important differences) assist in reframing the political discourse on reproductive autonomy? These questions and, we are sure, many others, would benefit from further attention. Thus it is our hope that this volume is merely the beginning of a long-standing, vigorous philosophical exploration of these common, yet all too frequently ignored, experiences. The editors would like to express their gratitude to the Kenneth Mark Drain Chair in Ethics at Trent University Trust for funds to make this issue open access in entirety.

An important consideration in reproductive bioethics is the question of personhood, which impacts family and medical decision-making as well as policy and law. Anthropology is uniquely suited to provide both a cross-cultural and historical and prehistorical perspective on the status of fetuses. Far from being taken for granted as a natural or biological condition, personhood is a status and identity actively negotiated, ascribed, and contested through social and cultural processes that are the particular concern of cultural anthropologists and bioarchaeologists. This chapter draws on both ethnographic and bioarchaeological research to demonstrate how and whether personhood was/is ascribed to fetuses in specific prehistoric, historic, and modern examples. While cultural anthropology has contributed to the discussion of personhood, identity, and bioethics for some time, bioarchaeology (i.e., study of human skeletal remains from the past) has only recently begun to investigate identity in the past. However, its development of a focus on fetal personhood is an important contribution to both bioarchaeology and to bioethics. This chapter demonstrates the possibilities for the meaningful integration of bioarchaeology and cultural anthropology into an evolving conversation on reproductive bioethics.

We evaluated the impact of cervical cerclage combined with one or more uterine contraction inhibitors in persistent inhibition of uterine contraction for the treatment of late abortion and premature delivery. This retrospective case series study analysed the medical data of 58 patients who underwent cervical cerclage for cervical insufficiency and simultaneously received one or more uterine contraction inhibitors (indomethacin, ritodrine, and atosiban) and magnesium sulphate at the Zibo Maternal and Child Health Hospital between January 2019 and December 2020. Patients are normal pregnancy who received cervical cerclage without complications. The rate of successful treatment was 74.14% (43/58). The prolonged gestation duration was 16.42 ± 7.84 weeks, and the average delivery gestational age was 35.91 ± 5.16 weeks. The longest duration of treatment with a uterine contraction inhibitor or inhibitors in combination or with magnesium sulphate alone was 15.34 ± 13.16 days, and nine cases developed adverse reactions. Persistent uterine contraction inhibition after cervical cerclage could prolong pregnancy and improve pregnancy outcomes. Impact statement What is already known on this subject? A crucial reason for treatment failure of cervical cerclage is that uterine contraction was not effectively inhibited. What do the results of this study add? Persistent inhibition of uterine contraction after cervical cerclage prolonged pregnancy duration, increased gestational age at delivery, and improved pregnancy outcomes. What are the implications of these findings for clinical practice and/or further research? This study may provide a clinical basis for prolonging gestational age, preventing late abortion and premature delivery, and improving the survival rate and quality of life of premature infants.

Use of low-molecular-weight heparin from the first trimester of pregnancy: A retrospective study of 111 consecutive pregnancies

The actions of pregnant women can cause harm to their future children. However, even if the possible harm is serious and likely to occur, the law will generally not intervene. A pregnant woman is an autonomous person who is entitled to make her own decisions. A fetus in‐utero has no legal right to protection. In striking contrast, the child, if born alive, may sue for injury in‐utero; and the child is entitled to be protected by being removed from her parents if necessary for her protection. Indeed, there is a legal obligation for health professionals to report suspected harm, and for authorities to protect the child's wellbeing. We ask whether such contradictory responses are justified. Should the law intervene where a pregnant woman's actions risk serious and preventable fetal injury? The argument for legal intervention to protect a fetus is sometimes linked to the concept of ‘fetal personhood’ and the moral status of the fetus. In this article we will suggest that even if the fetus is not regarded as a separate person, and does not have the legal or moral status of a child, indeed, even if the fetus is regarded as having no legal or moral status, there is an ethical and legal case for intervening to prevent serious harm to a future child. We examine the arguments for and against intervention on behalf of the future child, drawing on the example of excessive maternal alcohol intake.

Ethical Challenges and Implications of Deactivating Mechanical Circulatory Support for Patients With Preserved Cognitive Function.

Abortion, particularly later-term abortion, and neonaticide, selective non-treatment of newborns, are feasible management strategies for fetuses or newborns diagnosed with severe abnormalities. However, policy varies considerably among developed nations. This article examines abortion and neonatal policy in four nations: Israel, the US, the UK and Denmark. In Israel, late-term abortion is permitted while non-treatment of newborns is prohibited. In the US, on the other hand, later-term abortion is severely restricted, while treatment to newborns may be withdrawn. Policy in the UK and Denmark bridges some of these gaps with liberal abortion and neonatal policy. Disparate policy within and between nations creates practical and ethical difficulties. Practice diverges from policy as many practitioners find it difficult to adhere to official policy. Ethically, it is difficult to entirely justify perinatal policy in these nations. In each nation, there are elements of ethically sound policy, while other aspects cannot be defended. Ethical policy hinges on two underlying normative issues: the question of fetal/newborn status and the morality of killing and letting die. While each issue has been the subject of extensive debate, there are firm ethical norms that should serve as the basis for coherent and consistent perinatal policy. These include 1) a grant of full moral and legal status to the newborn but only partial moral and legal status to the late-term fetus 2) a general prohibition against feticide unless to save the life of the mother or prevent the birth of a fetus facing certain death or severe pain or suffering and 3) a general endorsement of neonaticide subject to a parent's assessment of the newborn's interest broadly defined to consider physical harm as well as social, psychological and or financial harm to related third parties. Policies in each of the nations surveyed diverging from these norms should be the subject of public discourse and, where possible, legislative reform.