Scott R
School of Law and Centre of Medical Law and Ethics, King's College London, UK.
Oxf J Leg Stud. 2000 Autumn;20(3):407-36. doi: 10.1093/ojls/20.3.407.
Although a pregnant woman can now refuse any medical treatment needed by the fetus, the Court of Appeal has acknowledged that ethical dilemmas remain, adverting to the inappropriateness of legal compulsion of presumed moral duties in this context. This leaves the impression of an uncomfortable split between the ethics and the law. The notion of a pregnant woman refusing medical treatment needed by the fetus is troubling and it helps little simply to assert that she has a legal right to do so. At the same time, the idea that a pregnant woman fails in her moral duty unless she accepts any recommended treatment or surgery--however great the burden--is also not without difficulty. This article seeks to find a way between these two somewhat polarized positions by arguing that, instead of being a question primarily about whether legally to enforce moral obligations, the 'maternal-fetal conflict' begins with previously unrecognized difficulties in determining when a woman's prima facie moral rights invoked in the treatment context should 'give way' to the interests of the fetus. This difficulty is mirrored within the law. Thus, how can we tell when a pregnant woman has the moral or legal duty to submit to a caesarean section? Seen in this way, the conflict is a problem which lies at the interface between moral and legal rights and duties, showing that there are important conceptual links between the ethics and the law. Against this background, this article explores the limits of a pregnant woman's right to bodily integrity by focusing upon the idea of her moral duty to aid the fetus through her body. Here we find difficulties in determining the existence and extent of this somewhat extraordinary duty. Such a duty is contrasted with both negative and positive duties toward others in the course of 'general conduct.' Attention to the social context of pregnancy and the refusal of treatment within this is also instructive. Overall, the purpose is to foster understanding and acceptance of the current legal position.
尽管现在孕妇可以拒绝胎儿所需的任何医疗治疗，但上诉法院承认伦理困境依然存在，并指出在这种情况下法律强制推行假定的道德义务是不合适的。这给人留下了伦理与法律之间令人不安的分裂印象。孕妇拒绝胎儿所需医疗治疗的观念令人不安，仅仅宣称她有这样做的合法权利并没有太大帮助。与此同时，认为孕妇除非接受任何推荐的治疗或手术——无论负担有多大——否则就未尽到道德义务的观点也并非毫无问题。本文试图在这两种略显两极化的立场之间找到一条出路，主张“母婴冲突”并非主要是一个关于是否从法律上强制推行道德义务的问题，而是始于在确定在治疗背景下女性所援引的初步道德权利何时应“让位于”胎儿利益时存在的先前未被认识到的困难。这一困难在法律中也有所体现。那么，我们如何判断孕妇何时有道德或法律义务接受剖腹产呢？从这个角度看，冲突是一个存在于道德和法律权利与义务之间的问题，表明伦理与法律之间存在重要的概念联系。在此背景下，本文通过关注孕妇通过身体帮助胎儿的道德义务这一理念，探讨孕妇身体完整性权利的限度。在这里，我们在确定这一有些特殊的义务的存在及范围时遇到了困难。这种义务与在“一般行为”过程中对他人的消极和积极义务形成对比。关注怀孕的社会背景以及其中的拒绝治疗情况也很有启发性。总体而言，目的是促进对当前法律立场的理解和接受。
