The Fetus, the "Potential Child," and the Ethical Obligations of Obstetricians
The Fetus, the "Potential Child," and the Ethical Obligations of Obstetricians
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DOI：
10.1097/aog.0000000000000225
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发表时间：
2014-05-01
影响因子：
7.2
通讯作者：
Liaschenko, Joan
中科院分区：
文献类型：
--
作者：
Minkoff, Howard;Marshall, Mary Faith;Liaschenko, Joan
孕妇有权拒绝产科干预是产科伦理学的既定原则。然而，这并不意味着胎儿的考虑是无关紧要的。虽然尊重消极自主权在很大程度上是一个已解决的问题，但不太清楚的是，孕妇的积极自主权（要求权）应在多大程度上起控制作用。我们讨论的伦理基础，决定当一个孕妇的肯定自主权应该是决定性的。我们关注的伦理后果时，胎儿被认为是一个“潜在的孩子”，因为一个女人的决定继续怀孕。她的意图决定了未来子女利益的相关性和性质。虽然胎儿的利益可能暂时接近一个出生的孩子，他们在所有情况下，仍然受到潜在的孩子的实际情况，即，孩子不能不治疗母亲的治疗。这种待遇会影响孕妇的身体完整权。这一权利对于我们的自主概念来说是如此重要，以至于它的侵犯应该让所有尊重基本人类尊严的人感到严重不安。因此，儿童的未来利益不应限制孕妇的消极自主权（拒绝任何旨在为胎儿或她自己的假定利益进行干预的权利）。然而，潜在儿童的利益可能会成为积极自主的考虑因素，同时也会成为医生拒绝特定干预或护理计划的权利的考虑因素。
The right of pregnant women to refuse obstetric interventions is an established tenet of obstetric ethics. However, that does not mean that fetal considerations are inconsequential. Although respect for negative autonomy is largely a settled issue, what is less clear is the degree to which a pregnant woman's affirmative autonomy (the right to demand) should be controlling. We discuss the ethical basis for deciding when a pregnant woman's affirmative autonomy should be decisive. We focus on the ethical consequences when a fetus is considered a "potential child" because of a woman's decision to continue a pregnancy. Her intention determines the relevance and nature of the interests of the future child. Although fetal interests may temporally approach those of a born child, they are, in all cases, still circumscribed by the de facto circumstance of the potential child, ie, the child cannot be treated without treating the mother. That treatment would implicate the pregnant woman's right to bodily integrity. This right is so fundamental to our conception of autonomy that its trespass should give serious pause to all who respect basic human dignity. Accordingly, the future interests of a child should not constrain a pregnant woman's right of negative autonomy (the right to refuse any intervention intended for the putative benefit of the fetus or herself). However, the interests of the potential child may factor into considerations of affirmative autonomy and, in parallel, on a physician's right to refuse a particular intervention or plan of care.