The fetus as patient: implications for directive versus nondirective counseling for fetal benefit

Abstract

The authors provide an ethical account of the fetus as patient and identify the implications of that account for directive versus nondirective counseling for fetal benefit. They argue that such an account cannot be grounded in the independent moral status of the fetus. Instead, the concept of the fetus as patient is best understood in terms of the principle of beneficence. On the basis of this principle, the fetus is a patient depending on whether links can be established between the fetus and the child it can become. The viable fetus is a patient. Directive counseling for fetal benefit of the viable fetus is appropriate, provided that it takes account of the presence and severity of fetal anomalies, extreme prematurity, and obligations to the pregnant woman. The previable fetus, including the in vitro embryo and the near-viable fetus, is a patient solely as a function of the pregnant woman's autonomous decision to confer such status. If she confers such status, the fetus is a patient and directive counseling is appropriate, provided that it takes account of the factors noted above. If she denies such status, the fetus is not a patient and nondirective counseling is appropriate.