Rethinking the Bioethics of Pregnancy: Time for a New Perspective?

Within the realm of bioethics, the construction of pregnancy classically has focused on principle-based ethics, essentially separating maternal and fetal interests. Respect for maternal autonomy becomes distinct from an obligation of fetal beneficence, placing practitioners in complicated ethical situations when the goals of pregnant women may be at odds with the best health interests of the fetus as defined by both professional groups and society in general. As a result, clinical care is framed by an ethical "maternal-fetal conflict," with important downstream legal and policy consequences for the well-being of pregnant women. Developments in the social sciences highlight the value of attending to the biosocial realm that a pregnant woman inhabits rather than relating to her and to her fetus as discrete entities. By understanding the needs, concerns, and context within which a woman lives, clinicians can practice an ethics of accompaniment. With a focus on an ethics of accompaniment, assumptions about the maternal moral responsibility to fetal health made by practitioners and society in general can directly affect not only clinical care, but also the way policy surrounding reproductive health is constructed and implemented.