The Ethical Dimension: Moral Decision-Making About Preterm Birth

Abstract

This chapter focuses on the ways that ethics and morality are defined in the context of high-risk pregnancies and preterm births in the U.S.: which values and principles are invoked, how authority and agency to make moral decisions are understood, and what types of ethical problems commonly occur. Ethical problems include conflicts between two moral principles held by the same individual, conflicts between the moral views of different parties, and conflicts over which parties have the standing to be involved in ethical decisions. Three sets of ethical decisions are examined in the context of high-risk pregnancies: whether women should receive multiple embryo transfers during in vitro fertilization (IVF) (a practice which increases the risk of preterm birth), whether pregnant women can be required against their own preferences to receive certain prenatal screenings, and who makes decisions about prenatal interventions. The chapter then examines ethical concerns in the decisions around resuscitation and the provision of life support for preterm newborns. For all of these decisions, the chapter reviews moral principles held and acted on by clinical care providers, by pregnant women and their families, and by the third parties who represent societal interests. Discussion of ethical issues in Canada, Great Britain, and Western Europe reflect all of the same concerns, but also, because of the publicly financed nature of their healthcare systems in these countries, consider the ethics of resource expenditures, an issue that is seldom openly discussed in the U.S.