Maternal Rights Research Articles

Blessed are the peacemakers: commentary on making peace in gestational conflicts.

The purpose of this commentary on James Nelson's article [1] is to advocate introducing the ethics of care into the arena of gestational conflict. Too often the debate gets stalled in a maternal versus fetal rights headlock. Interventionists stress fetal over maternal rights: they believe education, post-birth prosecution or pre-birth seizure of pregnant women may be permissible. In contrast to interventionists, other philosophers stress that favoring fetal rights treats women like 'fetal containers'. I question whether we should really consider issues of moral/parental obligations to children in terms of rights. Rather, the language of care should guide moral conduct vis-a-vis children/fetuses. The particularity of each woman's story--the particulars of her human relationships--inform her story. An individual's ability to care is largely a function of whether community cares for her. We must care for others to enable them to care for themselves and their loved ones--born or unborn.

The legal consequences for children born of chemically dependent mothers

The justice system has witnessed the negative consequences of chemical abuse. Infants are especially vulnerable to harm as a result of maternal drug use. This article uses a legal perspective to examine the conflict between maternal and fetal rights and reviews selected decisions and laws designed to protect children from maternal drug use. It advocates a policy of state intervention in order to protect children from the damage which can accompany maternal chemical use.

Drug Abuse and Pregnancy: Some Questions on Public Policy, Clinical Management, and Maternal and Fetal Rights

An estimated 9202 drug-exposed infants were born in the United States in 1986 according to the National Center for Health Statistics; the number increased to 13,765 in 1988. These figures were substantially underreported, however, notes the 1990 report by the U.S. General Accounting Office (GAO) (1). It surveyed 10 hospitals, two each in Boston, Chicago, Los Angeles, New York, and San Antonio, accounting for 44,655 births, of which approximately 4000 resulted in drug-exposed infants in 1989. Maternal cocaine use was estimated to range from below 1 to 12 percent among the 10 hospitals. The GAO report concluded that the number of these infants born nationwide each year could be "very high," and that in these five cities the unavailability of drug treatment and lack of adequate prenatal care are contributing to the problem (1). Two health professionals and a health lawyer were invited to respond to some questions about the problems of cocaine and substance abuse by pregnant women and how maternity caregivers, health and social service agencies, law, and society are dealing with the issues.

Whose Foetus Is It?

The evolving literature on foetal and maternal rights has been mesmerized by the potential conflicts between them.3 Sometimes these interests do clash, but often they may coincide. Abortion laws recognize that a woman's interests may be allowed to override those of the foetus.4 But some recognition of foetal interests, such as enforced caesarians and even restrictions on access to lawful abortion, may indeed be quite antithetical to the woman's interest.5 The feminist response to an argument for the recognition of foetal rights draws heavily on Mary Anne Warren's assertion that 'there is room for only one person with full and equal rights inside a single human skin.'6 In this essay, we want to accord more thought to the inter-dependence and inter-connectedness of a woman and her foetus.7 The maternal/foetal rights debate seems confounded by the notion that a woman may, in addition to her interest in determining whether her pregnancy is terminated, have an equally compelling interest in ensuring the preservation of her foetus.8 This is not a promotion of foetal rights; we want to try to reformulate some of the arguments to take account of a neglected dimension of the pregnant woman's interest in her foetus.Our argument will suggest that the use of legal instruments serves to protect a woman's foetus from her, and her from her foetus; but that it does not protect her foetus from others.9 The law treats the pregnant woman as if she were not pregnant; in mirroring the treatment of gender more generally, the law regards the pregnant woman as invisible. Our argument falls into three parts. First, we consider what interests are affected by foetal injury (and/or death) and whether a woman has interests in the safety of the foetus she is carrying which should be accorded legal protection. Secondly, we explore the extent to which criminal law already recognizes those interests and examine the reasons given for the limited scope of protection offered. Finally, we suggest how a recharacterization of the

Are pregnant women fetal containers?

Purdy explores the argument that women's rights to control their bodies should be subordinated to the welfare of their fetuses. She gives examples ofinstances where women's decisions about pregnancy and childbirth have been overridden by physicians and judges. She examines the nature of the mother fetus relationship, the social context of the current conflict between maternal and fetal rights, and the extent of a woman's legally enforceable duty to her fetus. Purdy acknowledges that women may owe a reasonable duty to their fetuses to try to prevent disease or handicap. However, given the uncertainties of modern medicine, the value-laden nature of many physicians' decisions, and the lack of adequate adequate prenatal care, women should not be held responsible for situations that are due largely to society's shortcomings. Purdy concludes that it is unjust to use the law to coerce women into accepting medical advice.

Abortion Revisited: Toward an Understanding of the Nature of the Woman-Fetus Relationship

The abortion debate, as presented by the prolife and prochoice perspectives, should end, as it leads neither to solution nor to compromise. Rather, we need to reconsider how to understand the moral issues involved in this controversy for they touch on how we understand ourselves as a people, how we understand women’s experience of pregnancy, and how such understanding affects what is considered important to us as a community. We need to move away from the “rights” perspective (from both fetal and maternal rights) in order to open other possibilities of understanding this issue. Ipropose that a more informed under standing of the nature of pregnancy itself can give a way to revisit this difficult and seemingly intractable moral controver sy and begin a more fruitful dialogue. The Inadequacy of the Rights Approach for Abortion First, I suggest that, although there are certain appeals, the rights approach has a number of limitations. The rights ap proach takes a relatively simplistic, linear view of pregnancy, with the view of fetus and woman as distinct beings. It argues for personhood of the fetus in the prolife camp and right of privacy and against the obligation of women to use their bodies to support fetal life in the prochoice camp (Meilaender, 1989). The rights approach is simplistic in that it ignores the com plexity of the woman-fetus relationship and supports the belief that taking sides for either the woman or the fetus will solve the problem. Second, the notion that an unwanted pregnancy is a problem to be solved is also questionable. Undergirding the problem solving approach is a technological attitude, an attitude that values diagnosis of specific causes in order to provide intervention which may alter or correct the problem. Such an approach is appropriate and necessary for problems that are technical in nature (Braine & Lesser, 1988). The unwanted pregnancy, how ever, is not such a situation. The unwanted pregnancy, as em bodied by the woman, is a situation filled with personal physical

Maternal rights versus fetal interests: an ethical issue with nursing implications.

A growing medicolegal concern for fetal life and health has culminated in court action asserting fetal interests over the rights of pregnant women to refuse medical treatment. Given the potential for increased legal protection of fetal interests in the future, nurses need to consider the ethical implications of legal action against pregnant women as a means to ensure fetal welfare. The risks, benefits, and potential consequences of the broad application of legal controls on maternal choice and behavior in pregnancy should be analyzed with respect to the rights of the mother, the interests of the fetus, and the goals of society. Relevant social and religious values need also be considered. An active nursing role in the application of an ethic of responsibility to clinical practice and public policy formation is a more effective means of serving both pregnant women and the unborn.

Ethical Issues in Prenatal Diagnosis

Prenatal diagnosis raises complex ethical issues not only in terms of individual decision making, but also in the development of clinical services and the formulation of public policy regarding access and funding. The motivation behind prenatal diagnosis is generally to provide the family with information regarding the pregnancy so that the outcome can be improved or, in the case of severely affected pregnancies, a decision can be made about pregnancy termination. Although many of the ethical issues involved in prenatal diagnosis and treatment overlap those common to all types of diagnostic procedures, the former situation is complicated by controversy about the moral status of the fetus and the use of selective abortion as a form of treatment. While there is general agreement that pregnancy termination after the 2nd trimester can be justified if the fetus is afflicted with a condition that is incompatible with postnatal survival or characterized by the virtual absence of cognitive functioning, the disposition of a fetus afflicted with a non-life-threatening physical or mental disability (e.g., Down's syndrome) is more controversial. An additional concern is that women with positive screening test results may choose elective abortion rather than undergo a definitive work-up. The issue of maternal versus fetal rights is perhaps the single most controversial dilemma. Here, the basic ethical dilemma is the conflict between respecting maternal autonomy versus acting beneficently toward the fetus. As a general rule, the more invasive the medical technique and the less certain the benefit to the fetus (e.g., laparotomy), the more difficult it is to make a convincing argument for forced interventions involving the mother's body. Situations in which compelling arguments can be made for forced interventions against the will of the mother are those where an otherwise healthy infant will die without immediate intervention or failure to perform a procedure will result in the birth of a newborn that is alive but seriously damaged. A final ethical issue is the need for the use of proxy decision makers for the fetus. Except in situations where there are doubts about a mother's capacity to make sound decisions, the role of proxy is ordinarily assigned to the parents.

Maternal Rights and Fetal Wrongs: The Case against the Criminalization of "Fetal Abuse"

Maternal Rights and Fetal Wrongs: The Case against the Criminalization of "Fetal Abuse"

The Inner Workings of an Ethics Committee: Latest Battle over Jehovah's Witnesses

Jehovah's Witnesses who refuse blood transfusions on religious grounds have long created ethical dilemmas for those in the medical profession trying to serve them. A bioethicist working in a clinical setting explores how one hospital ethics committee grappled with the additional problem of pregnant Jehovah's Witnesses, including the complex interdependence of maternal and fetal rights.

Eduardo De Filippo by Mario B. Mignone (review)

Book Reviews 139 MARlO B. MIGNONE. Eduardo De Filippo. Boston: Twayne Publishers 1984· Pp. 197. $18.95. The recent death of Eduardo De Filippo has deprived us of an extraordinary man of theater. He had participated in the life of theater as an actor, director, playwright, impresario, educator. In a long and fruitful career De Filippo wrote some forty-five plays, all of them performed by his own theater company, which he founded in 1945. Especially popular as an acror-playwright, De Filippo has often been linked to Moliere as a versatile comic genius. His works, offspring of the Neapolitan tradition of popular theater and, in particular. of the commedia dell 'arte, have been compared to the plays of Synge and O'Casey in their skillful use of local color and dialect. Drawing on extensive inteIViews with the playwright and attentively investigating his life and the iler of his dramatic art, Mario B. Mignone offers us the fIrst in-depth evaluation in English of the acclaimed artist. Mignone sets out to show how De Filippo found genuine inspiration in the reality of Naples, a paradoxical city in which the people are rich and poor; where they can, at the same lime, laugh and cry, love and hate, be religious and superstitious, ruthless and life loving. He rightly stresses that "De Filippo's attention is focused above all on the masses and lower middle class of Naples, on that part of the population for whom the tests of life are harder but not necessarily more tragic than those 'better off,' because they have an innate flair for life" (p. 21 ). Indeed, because the playwright could capture in their fullness these paradoxical aspects ofNaples, De Filippo achieved a high degree ofdrama and theatricality even in dealing with seemingly cerebral themes. For example, "the philosophy of the absurd, very evident in his plays, is not so much the subject matter of his characters' discussion as the Neapolitan way of life" (p. 23). Even the early plays of Dc Filippo, published under the title Cantata dei giomi pari, present a rich stylistic variety which avails itself of satire, irony, the grotesque, the comical, the humoristic, farce, caricature, sarcasm and buffoonery. These plays show the wretched reality of Naples during the Fascist period, and already reveal the characteristic critical attitude of the author, full of pathos. From these works was born the first defilippian character, Sik-Sik, who, even though possessing the traits of famous masks of the commedia dell 'arte, is actually a sad image of twentieth-century man who lives in solitude at the edges of life. Many defilippian characters are so immersed in their feelings and ideals that they do not succeed in seeing clearly their surrounding reality. For example, the protagonist of Chi e cchiu' felice 'e me!, in order to protect his ideal of happiness, is not at all upset by his wife's infidelity. The protagonists of these plays rarely succeed in realizing their desires; they are tragicomic, antiheroic figures who are approaching insanity as a result of the disintegration of their personalities. In Non ti pago. L'abito IlUOYO and various other works, the Neapolitan world assumes a pirandellian perspective. At the end of World War II, De Filippo's theater reflected neorealist tendencies. Indeed, De Filippo had already touched on the themes and ways ofneorealism in some of his early plays; now, the War having given him a more universal sense of history, he could write some of his best works in this style. Above all, he became preoccupied with Book Reviews the problems left by the War, with man's new hopes, with social changes. Mignone illustrates this special moment of defilippian art by carefully examining Napoli milionaria! and Filumena Marturano, especially the figure of Filumena. She is a character ofenonnous complexity, capable ofsimultaneously carrying on a fight against the prejudices of society, asserting her maternal rights and her most intimate feelings, inspiring in Domenico paternal feelings even for her sons born from her other relationships, and attaining her dream of having a family. The defilippian plays of the fifties, displaying pessimism and dealing with the theme ofthe relationship between reality and illusion, hide a philosophic...

Jefferson v. Griffin Spalding County Hospital Authority:Court-Ordered Surgery to Protect the Life of an Unborn Child

In Jefferson v. Griffin Spalding County Hospital Authority, the Supreme Court of Georgia affirmed a lower court order requiring a pregnant woman to submit to a cesarian section and other medical procedures necessary to save her unborn child's life. The court found that the state's interest in protecting the viable fetus outweighed the pregnant mother's right to religious practice, right to refuse medical treatment, and parental autonomy. Jefferson appears to stand for the proposition that fetuses have rights that attach at viability and that mothers have a corresponding duty to ensure live births. The decision foreshadows substantial conflict between fetal and maternal rights.

Maternal rights and health

T he text of proposed Senate Bill 158 reads in part: "human life shall be deemed to exist from conception, without regard to race, sex, age, health, defect, or condition of dependency; and for this purpose 'person' shall include all human life as defined herein." At conception there is cellular life, in biological terms. However, this bill attempts to integrate the presence of such cellular life with a legal definition of "personhood," with all the attendant rights of citizenry which are protected by the Fourteenth Amendment to the Constitution. When Congress equates cellular life with personhood, it is taking a substantial leap beyond the current views of the medical and scientific community that will have a major and lasting effect upon the health care of women in this country, the practice of medicine in this country, and the personal health practices of a large portion of our population. To declare rights for the conceptus equal to those of the woman will create competition for medical care, because the health interest of the fetus is not always consistent with the health interests of the pregnant woman. In fact, the physician potentially could be required to make medical decisions not in the best interest of woman or fetus, and possibly to the detriment of both. The majority of pregnancies in this country occur in circumstances in which the woman is understandably concerned with maintaining her own health and producing the healthiest child possible. Physicians offer care and advice to enhance the health and quality of life of the woman, both as an individual and as the bearer of children. In this role, the physician is committed to the best interests of the woman, who entrusts herself to his or her care. S. 158 would create insoluble problems for doctors in meeting this commitment. Some of the major advances in obstetrics over the past twenty years relate to the ability to evaluate the intrauterine status of the fetus and perform early delivery when indicated. Many of these premature births relate to maternal disease. Toxemia is a disease of pregnant women characterized by high blood pressure, possible convulsions, coma, and even death. Prevention of the more severe effects of this disease involves early delivery, with concomitant risk to the fetus. Failure to act in this situation for fear of abridging the rights of the fetus could result in the death of both mother and child. This bill would create impossible dilemmas for the practicing physician trying to meet his or her ethical responsibility to act in the best interest of the pregnant woman. Many diseases of pregnant women require procedures or medicines which pose a risk to the fetus. Examples include appendicitis and other abdominal surgery. Medications such as dilantin for the treatment of epilepsy and cortisone-like drugs for other conditions are necessary in the interest of the pregnant woman and pose an increased risk of fetal abnormalities. These are clearcut instances in which the physician has traditionally acted in the best interest of the pregnant woman. S. 158 would restrict this freedom. At issue is not only the concern pregnant women have for their own health, but also the desire of many women not to have a defective or severely handicapped child. Fortunately, we now have the ability to identify a number of these defects in early pregnancy and to offer a pregnant woman a choice as to whether or not she will bear a defective child. An example is Tay-Sachs disease. A baby born with this malady is doomed to die in early childhood. Are we to deny the woman the option of avoiding this tragic chain of circumstances for her and the rest of her living family? Women in today's society constitute an increasing part of our work force. As a result many are postponing childbearing and completing families after age 35. At this age, they are at increased risk that their pregnancy will have a genetic abnormality, Down's Syndrome, and current practice mandates that we offer them the opportunity for screening these unfortunate occurrences. The proposed legislation would essentially nullify our current efforts at genetic screening programs. The woman who is not pregnant also has a vital and justified interest in the maintenance of good health, which would be impacted by this legislation. For over ten million women in this country, the exercise of selfdetermination includes management of their reproductive functions by means of the intrauterine device and the birth control pill. If the legislation as proposed were to pass, any known contraceptive which interferes with the