Refusal of interventions to protect the life of the viable fetus--a case-based Transatlantic overview.

Dr Kevin J Dalton LLM FRCOG FCLM Dept Obstetrics & Gynaecology, University of Cambridge, Addenbrooke’s Hospital (Box 223), Cambridge CB2 2QQ, [email protected] It is rare for a pregnant woman to refuse a recommended intervention to protect the life of her viable fetus, and few obstetricians have ever come across the problem. Nevertheless, a number of cases of such a refusal have gone to court for resolution, and some have even reached the Supreme Court of the United States. In England such disputes have always been resolved at or below the Court of Appeal. In the United States, federal and state laws are not unanimous on whether the mother’s refusal to accept treatment should always prevail whenever there is a maternal-fetal conflict of interest. By contrast, in English law the matter is at present firmly settled in favour of a competent mother’s right to refuse, on the grounds that respecting her autonomy must always trump the protection of any fetal interest. The question of whether a mother’s refusal to undergo a recommended treatment should be overridden in favour of her viable fetus is fundamentally one of balancing maternal rights against any fetal rights that are recognised by law, or recognised in ethics. But here it is most important to recognise that what may be required or allowed by law may not be required or allowed in an ethical context. The question of fetal rights vis-á-vis maternal rights remains unsettled in law and ethics.