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The The fetus as a patient: different positions on the same concept
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Published:
Oct 1, 2021
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2021-10-01 (1)
Keywords:
fetus, person, patient, fetal surgery, eugenic abortion, personalism, principlism
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Abstract
Congenital anatomical malformations, such as genetic disorders, are a current and frequent cause of eugenic abortion in countries where abortion is decriminalized and/or legalized. Diagnostic and therapeutic fetal medicine, including intrauterine fetal surgery, has placed the fetus as a new patient in the universe of biomedical science. To state that the fetus is a patient would mean recognizing that it is a person. To know whether a fetus is a patient or not, it must be established whether it has an independent moral status. In this article we will analyze three positions on the consideration of the fetus as a patient.
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Moreno D’Anna, M. M. de las M., & Páez, G. (2021). The The fetus as a patient: different positions on the same concept. Revista De Medicina Y Ética, 32(4), 989–1009. https://doi.org/10.36105/mye.2021v32n4.03
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References
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25. Sulmasy D.P. The varieties of human dignity: A logical and conceptual analysis. Med Health Care and Philos. 2013; 16: 937-944. https://doi.org/10.1007/s11019-012-9400-1
26. López Moratalla N. Comunicación materno filial en el embarazo. Cuad. Bioét. XX. 2009; 3: 303-315.
27. Levin SB. Upgrading discussions of cognitive enhancement. Neuroethics. 2016; 9: 53-67. https://doi.org/10.1007/s12152-016-9253-z
28. Singer P. Ética práctica. Barcelona: Ariel, 1991.
29. Flores Muñoz MA. Las intervenciones en el feto, el dolor y sus dilemas bioéti- cos. Perinatol. Reprod. Hum. 2014; 28(2): 114-118. Disponible en: http:// www.scielo.org.mx/pdf/prh/v28n2/v28n2a8.pdf
30. Báez Reyes MR. El feto y los derechos humanos. Rev Sanid Milit Mex. 2010 May-Jun; 64(3): 125-132.
31. Chervenak F, McCullough L. Ethics of fetal surgery. Clin Perinatol. 2009; 36. 237-246. https://doi.org/10.1016/j.clp.2009.03.002
32. Gómez Fajardo CA. Anotaciones críticas sobre algunos sofismas en medicina materno-fetal. Revista Lasallista de Investigación. 2014; 11(1), 152-160. https://doi.org/10.22507/rli.v11n1a18
33. Selgelid M.J. Moral uncertainty and the moral status of early human life. J Med Ethics. 2013 May; 39(5): 324. https://doi.org/10.1136/medethics-2012-101164d
34. Mills E. Early abortion and personal ontology. Acta Anal. 2013; 28: 19-30. https://doi.org/10.1007/s12136-012-0182-0
35. García JJ. Bioética personalista y bioética principialista. Perspectivas. Cua- dernos de Bioética XXIV. 2013/1a.
36. Dickens BM, Cook RJ. Ethical and legal approaches to «The fetal patient». 83 International Journal of Gynecology and Obstetrics. 2003; 85-91. https://doi.org/10.1016/s0020-7292(03)00320-5
37. Rodrigues HC, Van Den Berg PP, Düwell M. Dotting the I’s and crossing the T’s: Autonomy and/or beneficence? The «fetus as a patient» in maternal-fetal sur- gery. J Med Ethics. 2013; 39(4): 219-223. https://doi.org/10.1136/medethics-2012-100781
38. De Vries R. Obstetric Ethics and the invisible mother. Narrat Inq Bioeth. 2017; 7(3): 215-220. https://doi.org/10.1353/nib.2017.0068
39. Radic JAE, Illes J, McDonald PJ. Fetal repair of open neural tube defects: Ethical, legal, and social issues. Camb Q Healthc Ethics. 2019; 28(3): 476-487. https://doi.org/10.1017/S0963180119000409
40. Cohen S. The logic of the interaction between beneficence and respect for autonomy. Med Health Care Philos. 2019; 22(2): 297-304. https://doi.org/10.1007/s11019-018-9876-4
41. Saad TC. The history of autonomy in medicine from antiquity to principlism. Med Health Care Philos. 2018; 21(1): 125-137. https://doi.org/10.1007/s11019-017-9781-2
2. Matar A. Hansson MG. Höglund AT. Values and value conflicts in implementation and use of preconception expanded carrier screening: An expert interview study. BMC Med Ethics. 2019; 20(1): 25. https://doi.org/10.1186/s12910-019-0362-1
3. Stapleton G, Dondorp W, Schröder-Bäck P, De Wert G. Just choice: A Danielsian analysis of the aims and scope of prenatal screening for fetal abnormalities. Med Health Care Philos. 2019; 22(4): 545-555. https://doi.org/10.1007/s11019-019-09888-5
4. Shea M. The quality of life is not strained: Disability, human nature, well-being, and relationships. Kennedy Inst Ethics J. 2019; 29(4): 333-366. https://doi.org/10.1353/ken.2019.0029
5. Best M. The dilemma of prenatal screening. Ethics & Medicine. 2018; 34(2): 113. 6. Nuccetelli S. Abortion for fetal defects: Two current arguments. Med Health Care Philos. 2017; 20(3): 447-450. https://doi.org/10.1007/s11019-017-9765-2
7. Campbell SM, Stramondo JA. The Complicated relationship of disability and well-being. Kennedy Inst Ethics J. 2017; 27(2): 151-184. https://doi.org/10.1353/ken.2017.0014
8. Mayo Clinic. Rochester. (Consultado el 28 de febrero de 2021). Disponible en: https://www.mayoclinic.org/es-es/tests-procedures/fetal-surgery/about/pac- 20384571.
9. Wenstrom KD, Carr SR. Cirugía fetal: principios, indicaciones y evidencia. Obstet Gynecol. 2014; 124: 817-835. https://doi.org/10.1097/AOG.0000000000000476 10. Knezevich M, Koehler SM, Wagner A. The Evolution of fetal surgery. Division of pediatric surgery, Department of Surgery, Medical College of Wisconsin; Mil- waukee, WI. 2017. Disponible en: www.openaccesspub.org.
11. Huamán Guerrero M. Historia de la cirugía fetal. Rev Peru Ginecolog Obstet. 2019; 65(4): 479-485. https://doi.org/10.31403/rpgo.v65i2208
12. Vuletin F. Nuevos desafíos en cirugía fetal. Rev. Chil. Pediatr. 2013; 84(3): 254-261. http://dx.doi.org/10.4067/S0370-41062013000300002
13. Antiel RM, Collura CA, Flake AW, et al. Physician views regarding the benefits and burdens of prenatal surgery for myelomeningocele. J Perinatol. 2017; 37(9): 994-998. https://doi.org/10.1038/jp.2017.75
14. Fry JT. Frader JE. «We want to do everything»: How parents represent their experiences with maternal-fetal surgery online. J Perinatol. 2018; 38(3): 226-232. https://doi.org/10.1038/s41372-017-0040-4
15. Lukac de Stier, ML. La antropología tomista de Guillermo Blanco. Sapientia. 2011; 67: 229-230. Consultado en: http://bibliotecadigital.uca.edu.ar/repositorio/re- vistas/antropologia-tomista-blanco-stier.pdf
16. Briozzo L, et al. Abordaje clínico del conflicto de interés materno fetal y su relación con el estatus del feto como paciente. Rev Méd Urug. 2013; 29(3): 187-194. 17. Kanaris C. Foetal surgery and using in utero therapies to reduce the degree of disability after birth. Could it be morally defensible or even morally required? Med Health Care Philos. 2017; 20(1): 131-146. https://doi.org/10.1007/s11019-016-9727-0
18. Chervenak FA, McCullough LB. The fetus as a patient: An essential concept for the ethics of perinatal medicine. Am J Perinatol. 2003 Nov; 20(8): 399-404. https://doi.org/10.1055/s-2003-45383
19. Chervenak FA, McCullough LB. An ethically justified framework for clinical in- vestigation to benefit pregnant and fetal patients. Am J Bioeth. 2011; 11(5): 39-49. https://doi.org/10.1080/15265161.2011.562595
20. ONU. Declaración Universal de los Derechos Humanos. Ginebra 1948. (Consultado el 19 de marzo de 2021). Disponible en: https://www.un.org/es/about-us- universal-declaration-of-human-rights
21. Sebastiani M. Análisis ético bajo el concepto del feto como paciente en los casos de anencefalia. Comité de Bioética del Hospital Italiano de Buenos Aires. Sep. 2001.
22. García JJ. Bioética personalista y bioética principialista. Perspectivas. Cuadernos de Bioética. 2013; 24(1): 67-76.
23. Melina L. El embrión humano: estatuto biológico, antropológico y jurídico. Actas del Congreso Internacional de Bioética. Bioética y dignidad en una socie- dad plural. Pamplona 1999. (Consultado el 19 de marzo de 2021). Disponible en: https://www.unav.edu/web/unidad-de-humanidades-y-etica-medica/material-debio-etica/congreso-internacional-bioetica-1999/el-embrion-humano#cap1
24. Arango Restrepo P. Estatuto del embrión humano. Escritos. 2016; 24(53): 307-318. https://doi.org/10.18566/escr.v24n53.a04
25. Sulmasy D.P. The varieties of human dignity: A logical and conceptual analysis. Med Health Care and Philos. 2013; 16: 937-944. https://doi.org/10.1007/s11019-012-9400-1
26. López Moratalla N. Comunicación materno filial en el embarazo. Cuad. Bioét. XX. 2009; 3: 303-315.
27. Levin SB. Upgrading discussions of cognitive enhancement. Neuroethics. 2016; 9: 53-67. https://doi.org/10.1007/s12152-016-9253-z
28. Singer P. Ética práctica. Barcelona: Ariel, 1991.
29. Flores Muñoz MA. Las intervenciones en el feto, el dolor y sus dilemas bioéti- cos. Perinatol. Reprod. Hum. 2014; 28(2): 114-118. Disponible en: http:// www.scielo.org.mx/pdf/prh/v28n2/v28n2a8.pdf
30. Báez Reyes MR. El feto y los derechos humanos. Rev Sanid Milit Mex. 2010 May-Jun; 64(3): 125-132.
31. Chervenak F, McCullough L. Ethics of fetal surgery. Clin Perinatol. 2009; 36. 237-246. https://doi.org/10.1016/j.clp.2009.03.002
32. Gómez Fajardo CA. Anotaciones críticas sobre algunos sofismas en medicina materno-fetal. Revista Lasallista de Investigación. 2014; 11(1), 152-160. https://doi.org/10.22507/rli.v11n1a18
33. Selgelid M.J. Moral uncertainty and the moral status of early human life. J Med Ethics. 2013 May; 39(5): 324. https://doi.org/10.1136/medethics-2012-101164d
34. Mills E. Early abortion and personal ontology. Acta Anal. 2013; 28: 19-30. https://doi.org/10.1007/s12136-012-0182-0
35. García JJ. Bioética personalista y bioética principialista. Perspectivas. Cua- dernos de Bioética XXIV. 2013/1a.
36. Dickens BM, Cook RJ. Ethical and legal approaches to «The fetal patient». 83 International Journal of Gynecology and Obstetrics. 2003; 85-91. https://doi.org/10.1016/s0020-7292(03)00320-5
37. Rodrigues HC, Van Den Berg PP, Düwell M. Dotting the I’s and crossing the T’s: Autonomy and/or beneficence? The «fetus as a patient» in maternal-fetal sur- gery. J Med Ethics. 2013; 39(4): 219-223. https://doi.org/10.1136/medethics-2012-100781
38. De Vries R. Obstetric Ethics and the invisible mother. Narrat Inq Bioeth. 2017; 7(3): 215-220. https://doi.org/10.1353/nib.2017.0068
39. Radic JAE, Illes J, McDonald PJ. Fetal repair of open neural tube defects: Ethical, legal, and social issues. Camb Q Healthc Ethics. 2019; 28(3): 476-487. https://doi.org/10.1017/S0963180119000409
40. Cohen S. The logic of the interaction between beneficence and respect for autonomy. Med Health Care Philos. 2019; 22(2): 297-304. https://doi.org/10.1007/s11019-018-9876-4
41. Saad TC. The history of autonomy in medicine from antiquity to principlism. Med Health Care Philos. 2018; 21(1): 125-137. https://doi.org/10.1007/s11019-017-9781-2