Mohaupt S M, Sharma K K
Institute of Psychiatry, Law, and the Behavioral Sciences, University of Southern California, Los Angeles, USA.
J Forensic Sci. 1998 Sep;43(5):985-92.
The purpose of this paper is to review the issue of fetal rights from primarily a legal perspective, with consideration of morals and professional ethics. The practice of medicine is fraught with numerous bioethical dilemmas. These dilemmas often leave the physician wondering if he has made the correct decision. A physician's morals and professional ethics may influence his or her decision in resolving bioethical dilemmas. The case example is a 34-year-old female with a 41-week intra-uterine pregnancy. The mother was refusing induction of labor. Without the labor induction, the fetus may die. Despite this risk, the mother desired to pursue a vaginal delivery. The AMA's ethics state that a competent, pregnant mother's wishes should prevail and the court should not be involved unless there are unusual circumstances. The mother in the case example was competent and informed consent was provided. Case law does not specifically address the dilemma of the case example. However, there is case law regarding court-ordered cesarean sections which reveals different opinions. The difference in court opinion encompasses the relative degree of weight given to the fetus's right to be born healthy and alive versus the mother's privacy rights. Some courts describe this "balancing test," whereas others state that the mother's privacy rights prevail unless there are exceptional circumstances, which will be extremely rare. The fetus has acquired rights in other areas of the law; for example, abolishment of the intra-family immunity doctrine and the definition of murder in most states. In considering the legal arena of fetal versus maternal rights, a decision tree is presented to assist physicians in assessing cases of a pregnant mother refusing medical treatment. There is no precise demarcation in assessing fetal and maternal rights. The greater the degree of fetal viability, the greater degree of fetal rights. Consideration must also be given to the relative degree of invasiveness to the mother for the proposed procedure; the more invasive, the greater degree of maternal rights. Each case must be evaluated on an individual basis and the decision tree can assist a clinician with this process.
本文旨在主要从法律角度审视胎儿权利问题，并兼顾道德和职业道德。医学实践充满了众多生物伦理困境。这些困境常常让医生怀疑自己是否做出了正确的决定。医生的道德和职业道德可能会影响其在解决生物伦理困境时的决策。案例是一位34岁、怀有41周宫内妊娠的女性。母亲拒绝引产。不进行引产，胎儿可能会死亡。尽管有此风险，母亲仍希望顺产。美国医学协会的伦理准则规定，有行为能力的怀孕母亲的意愿应占上风，除非有特殊情况，否则不应涉及法院。案例中的母亲有行为能力且已获得知情同意。判例法并未具体涉及该案例中的困境。然而，有关于法院下令进行剖宫产的判例法，其显示了不同的观点。法院观点的差异包括给予胎儿健康存活权利与母亲隐私权的相对权重程度。一些法院描述了这种“平衡测试”，而另一些法院则表示，除非有极其罕见的特殊情况，母亲的隐私权应占上风。胎儿在其他法律领域已获得权利；例如，家庭内部豁免权原则的废除以及大多数州对谋杀的定义。在考虑胎儿与母亲权利的法律领域时，提出了一个决策树，以协助医生评估怀孕母亲拒绝医疗治疗的案例。在评估胎儿和母亲权利时没有精确的界限。胎儿的存活能力越强，胎儿权利的程度就越高。还必须考虑拟议程序对母亲的侵入程度；侵入性越强，母亲权利的程度就越高。每个案例都必须单独评估，决策树可以帮助临床医生进行这一过程。
