ETHICAL ISSUES IN OBSTETRICS

Ethical issues in modern obstetrics commonly relate to a conflict betw een the rights and possibilities of the fetus versus those of the moth er. After delivery, when the fetus by definition is a child, all legal rights are granted to this new individual. Whether any rights should be given or offered to the fetus is dependent on the prevailing situat ion. General rules are difficult to give due to the rapid evolution of clinical medicine-too firm rules given today could well be an obstacl e in the near future. All cultures have well-established opinions rega rding issues related to pregnancy and childbirth. Cultural and religio us dogmas are often in conflict with modern medical technology and fin ancial issues. In several modern societies, state laws regulate legal abortion and other aspects of termination of pregnancy. Current laws o ften determine not only decisions but also the minds of doctors, as we ll as of patients. Advanced medical technology has yielded a possibili ty of selective feticide. Again our experience with this new technique is Limited, and several issues of ethical importance may arise from t he use of such techniques. The indications for a selective feticide ar e dependent upon the benefits and risks of the procedure itself, and a lso on the selection process of what fetus should be aborted. Clearly, no definitive rules could be given at this stage of development. The advice given to the woman by her doctor is of critical importance for the outcome of the given pregnancy, be it selective feticide or legal abortion. However, the prevailing social welfare system and the suppor t a woman could be given by her society are also factors. Should she g ive birth to a child with an inborn error of metabolism, or some other chronic illness? Drug abuse, including alcohol and, indeed, also toba cco, constitutes a special problem. In Sweden, drug-addicted pregnant women are hospitalized during their last trimester. This policy result s in a drug-free last trimester and a reduction of afflicted newborns. Should a similar approach also be enforced when dealing with abuse of alcohol and tobacco during pregnancy? The improvement of in vitro fer tilization techniques has introduced a novel concept, the surrogate mo ther. In some countries, this is forbidden by law, in others, it is an accepted medical practice, but several medico-legal as well as ethica l issues warrant further clarification. What are the legal rights of t he surrogate mother, Should there be an age limit for surrogate mother s? Who is responsible for problems in the pregnancy itself? In cases o f male infertility, ethical issues may arise. Should the child have a legal right to learn the name of the biological father? Should there b e a limit for the use of donor sperm in respect to number of fertility attempts, as well as potential female patients who may use the same s perm donor?.