Fetal-Maternal Complex as a Project: Feminist Bioethical Examination of the “Fetus as a Patient”

Abstract This article examines the fundamental ethical question of fetal therapy, specifically, the recognition of the fetus as a patient. Fetal therapy has developed under this widely known concept in medical ethics, conceptualized by Chervenak and McCullough, but there is an ethical problem: treating the fetus as a patient leads to a disregard for the welfare and rights of the pregnant woman, despite the fact that the pregnant woman is also the subject of interventions in fetal therapy. This article addresses criticisms directed at the concept of “the fetus as a patient” from the feminist bioethical standpoint and demonstrates related problems. This concept obscures the pregnant woman’s personhood, downplays the maternal impact of fetal therapy by separating the pregnant woman from the fetus, and presupposes maternal responsibility to undergo fetal therapy without argument. On the other hand, traditional feminist bioethics has argued that only the pregnant woman is the patient, i.e., the one-patient model as opposed to the two-patient model. This position, however, has a flaw in that it conflates the risks and benefits of the fetus with those of the pregnant woman, leading to voluntary self-sacrifice. Therefore, from a perspective of feminist bioethics, this article proposes a “fetal-maternal complex” model, in which the pregnant woman and the fetus are viewed as an inseparable complex, while their risks and benefits are assessed separately, with an emphasis on the physician’s beneficence-based obligations to the pregnant woman.