MATERNAL -

FETAL
CONFLICTS
 Maternal - Fetal Conflicts
 Occur when a pregnant woman’s
interests conflict with the interests
of her fetus.

 Requires dealing with 2 patients:

the mother and the fetus
Such conflicts occur when…
 A pregnant woman decides not to
comply with recommendations that her
physician considers to be in the best
interest of the fetus
 On the other end, when a pregnant
woman refuses therapy or any
intervention because it will endanger
her baby
 What is the best method of
resolving this situation?

 What are the moral obligations of

the physician to the pregnant
woman and to the fetus?
 Moral status of the fetus
 When does human life begin?
 There are currently 3 ways of
approaching this issue:
 Full fetal rights
 No rights
 Increasing rights with advancing
gestation
 Pope Pius XII has said, “Life, from
the moment of its inception is
sacred.”
 Life is God’s gift and to be valued
as such, a gift to be protected,
cherished and upheld; so that as far
as the moral status of the embryo is
concerned, its status, rights and
dignity are equal to that of the
mother’s.
 As a rule, in maternal-fetal conflicts,
what is beneficial to one is detrimental
to the other and vice-versa.
 There will be some instances where
the benefit to one is negligible while to
the other, it is maximal.
 When we cannot hope to attain the
best consequences for both, whose
benefits do we give greater weight to?
 Both mother and fetus have the
right not to be harmed, the right not
to be killed, the right to be aided in
times of need, to be treated as an
end.
 But in the face of conflicting rights,
whose rights should prevail?
 Basic issue is: We have two
patients whose best interests
conflict.
 PRINCIPLE OF DOUBLE
EFFECT

- Serves as guiding principle in maternal-fetal

conflict.
5 Conditions:
1. The action itself must be morally
good or at least indifferent.

 Action itself independent of its effect.

 Action should be fair.
2. The intention of the agent should
be directed towards the good effect.

 Direct voluntary
1. The evil effect must never be
directly intended.

 Indirect voluntary.
1. There should be no relationship of
causality.

 Evil effect must not cause the good

effect.
5. Proportionality.

 The good must compensate for the evil.

 Role of the health provider
 It is the moral responsibility of the
health professional to provide his
patient with an accurate “risk
assessment.”
 Support a patient’s informed and free
decision regarding a treatment
process, as far as the physician’s
personal values would allow.
 The health provider should not feel
obliged to provide a service which
conflicts with his values and he
should openly communicate this
information to his patient at the
onset of the patient-physician
relationship.
 Maternal-Fetal
Conflict
Case 1
Abruptio Placentae –premature separation, in part or wholly, from
the uterine wall of the placenta at its normal
site

-results in hemorrhage at the site of detachment

-the degree of separation may vary from being

slight and harmless to complete separation;
maternal mortality nearing 30%
 Moral Aspects:
 Abruptio Placentae occurs near term or at the onset of labor, when the
fetus is viable – OB will do all that he can to save the lives of both the
mother and child

 If however, occurs before the fetus is viable, the following points are
important:

* When the maternal hemorrhage is mild and not endangering the

mother’s life – no steps can be taken which would even indirectly
expose the life of the fetus to any danger

* Even if the hemorrhage becomes serious, the directly intended

removal of a non-viable fetus from the uterus is direct abortion and is

never permitted
* When the maternal life is in danger from hemorrhage it

is morally permissible to try to control the bleeding by

drug therapy or tamponade

* The removal of a dead fetus at any stage of

development is obviously not wrong
 Case 2
Fetal anencephaly
– prognosis of the fetus was extremely poor

- lack a functioning cerebral cortex

- majority are stillborn, and most that are born alive die
within 24 hours of birth; death almost always occur
within 2 weeks
*Other moralists approach…”Brain function is the criterion that
would make man unique in the whole animal kingdom, the
initial evidence of organic brain function would determine the
point of personhood”
- WRONG

*Pope Pius XII…”Life from the moment of its inception is

sacred”
- CORRECT/ MORAL
 Under such circumstances, immediate steps may be taken to
remove the fetus, even though some trace of fetal life remains.
Such procedure puts the fetus in no worse an env’t, and is therefore
permitted. - WRONG

 The fetus will have a short non-sentient existence regardless of

what is done, so a prompt death associated with abortion would not
deprive it of any benefit, due to the absence of awareness.
- WRONG
# In the article, the Catechism entry 2270
“As the 5th commandment makes clear, human life fully
begins as the moment of conception, when the egg is
fertilized, and must be absolutely respected and protected
as such from that moment onwards”
“CHILDREN are a BLESSING from the
LORD, the FRUIT of the WOMB a
REWARD”
(Psalm 127:3)

* Let the fetus die a natural death

if that’s what the Lord intended.
 Case 3
 The patient was a 37-yr old pregnant woman at 30 weeks gestation…Bone
marrow aspiration and biopsy revealed 100% cellularity with increased
lymphoid infiltrates. It revealed B-cell acute lymphocytic leukemia (ALL).
 After the consultation, medical management plan was developed that
postponed chemotherapy for the patient to allow fetal lung maturity because
platelet count were still within normal ranges
 Within 1 week, however, the WBC ct. dropped from 5.7-2.9 x10 3/mm3 and
her Hemoglobin decreased from from 8.9-7.9 g/dl. (Increased activity of
leukemia in Bone Marrow)

ETHICAL DILEMMA: *Begin chemo to treat ALL – harm the fetus

*Not begin chemo – could lead to the death of

mother
*Continue pregnancy and not treating woman – harm

both
Starting therapy: + in favor of maternal well-being
- to the disadvantage of fetal well-being

Delaying therapy: + in favor of fetal well-being

- to the disadvantage of maternal well-being

MCCB document, Ethical and Religious Directives for Catholic

Health Services (1995)…

”Operations, treatments and medications that have as their

direct purpose the cure of a proportionately serious
pathological condition of a pregnant woman (may result to
her death) are permitted when they cannot be safely
postponed until the unborn child is viable”