Saint Didacus, Fetal Death, and the Problem of Dual Loyalty

( N Engl J Med . 391;20. doi:10.1056/NEJMp2402783.) One Christmas morning, an emergency call in labor and delivery marked the beginning of a deeply emotional and ethically complex situation for a physician. A woman, involved in a car accident and found to be intoxicated, had suffered a fetal demise at 20 weeks gestation. After counseling, she opted for an induction to deliver the stillborn fetus. As the labor progressed, the physician learned that the woman had other children at home and had been sober for several years. After the delivery, the physician helped with the care of the fetus and then made a required phone call to report the fetal death to the medical examiner, as per legal obligations in Massachusetts for any fetal death after 20 weeks. The cause of death was trauma from the car crash, exacerbated by alcohol use. This act of reporting, however, led to significant ethical dilemmas for the physician, who feared potential legal consequences for the mother.