This site and the resources it recommends rely on a natural law perspective to guide ethical decision making. This perspective uses reason to identify moral principles that apply to all human beings, regardless of religion, philosophy, cultural heritage, or politics. Natural law aims at universal goods that everyone can recognize.1
Termination Questions
Is terminating a pregnancy after a prenatal diagnosis and before the baby is viable a type of abortion?
A pre-viability early induction terminates a pregnancy through the induction and delivery of a baby before the baby can survive outside the womb without intervention. There are some circumstances where artificially separating the mother and child may be medically necessary to save the life of the mother or the child. When neither life is at risk, a pre-viability early induction is a type of abortion, even if the child doesn’t die until after birth, because the intention is to prematurely end the baby’s life.2
What if a baby will suffer by choosing to continue a pregnancy?
The safest place for the baby is the womb, and a child may not be suffering nor be aware of anything he or she is lacking. Ending his or her life prematurely can cause suffering, as unborn babies can feel pain possibly as early as 12 weeks gestation and certainly by 15.3
There is no way for anyone to say exactly when a person will die, but even if a person is believed to be dying does not justify directly killing him or her to hasten their death. Perinatal hospice is an alternative that resembles hospice end of life care for the elderly or terminally ill, offering an opportunity to make the most of limited time.
Care for Baby
Do parents have to provide extraordinary care for baby? What about ordinary care?
Ordinary care is care that is ordinarily provided to all people in a similar situation. Stabilization and evaluation are standard practice in neonatal medicine wherein at birth an infant is provided with sufficient general respiratory support to stabilize the baby so an evaluation can be completed. All infants benefit from stabilization and evaluation.
Extraordinary care, also called aggressive care, refers to medical care that is disproportionate to the expected outcome.4 Extraordinary means are medicines, treatments and operations that do not provide a benefit, and/or involve excessive burden, pain, or expense. Natural Law does not require seeking or providing extraordinary care, though parents may choose to explore extraordinary care options.
In the decision-making process for care of the unborn child, parents deserve to be informed of potential treatments or procedures, along with their risks and benefits for their baby. Parents deserve access to the care they want for their child. If a hospital is unable or unwilling to provide care, parents may ask the hospital or consult other resource to find another hospital that might provide that care. If multiple medical consultations recommend against extraordinary care, parents deserve support in coming to terms with this grief.
Ordinary or extraordinary care may vary by diagnosis. Parents may benefit from the assistance of an ethical consultation in addition to their medical team to assist them in the decision-making process.
Is it unethical to decide before the baby’s birth to limit a baby's care, or after birth to limit direct intubation one way or another?
When medical technology cannot predict with absolute certainty how a baby will fare following birth, it is appropriate to plan for all possible outcomes5. This includes the possibility for parents to choose to plan to limit extraordinary care after a baby’s birth.
Following birth, the child is first stabilized and evaluated and given ordinary care. What can be done after birth depends on both the condition of the child and the gestational age of the child. The baby’s condition and age may determine if it is even possible to intubate and if doing so could have any possible positive outcomes, such as time to evaluate treatment options or extending time with baby (for baptism, meeting siblings etc.).
Is perinatal hospice an ethical option for a baby with a life-limiting condition?
Perinatal hospice is hospice care provided while baby is in the womb6, and is a positive choice when the following are all taken into consideration:
- The life-limiting condition has been confirmed with a prenatal diagnostic test. (A positive screening test indicates the likelihood of the life-limiting condition, not a confirmed diagnosis.)
- Parents have been informed of all options, and understand what services are offered with perinatal hospice, what other options are available, and what choosing not to have extraordinary medical interventions means for their child's care.
- There is some element of stabilization and evaluation for the baby at birth to provide an opportunity to confirm any prenatal tests results.
- Provisions are made to provide for ordinary care such as feeding that is not burdensome.
- Some apply the term “perinatal hospice” for post-birth comfort care measures which may more properly be considered bereavement care. This article provides more information.
If any parents have any concern regarding particular circumstances, they may wish to initiate an ethics consultation.
What can a parent do who is experiencing regret or has any questions concerning past decisions?
It is understood that parents make the very best decision they know how to make with the information they were given. If a parent has questions regarding particular circumstances surrounding a previous decision, they may wish to have an ethics consultation.
Anyone experiencing regret may wish to visit the webpage on Pregnancy Loss. Local and national support may also be found by searching on HerPLAN.org at the following searches:
- This link is for searching abortion recovery and healing.
- This link is for searching pregnancy and infant loss support.
- This link is for searching counseling for women and families.
- This link is for searching prenatal diagnosis support organizations.
The above links provide specific assistance in local areas and national virtual resources.
Sources:
- There are a variety of definitions that similarly describe Natural Law. Here is an example: https://www.britannica.com/topic/natural-law
- https://aaplog.org/wp-content/uploads/2022/10/PG-10-Concluding-Pregnancy-Ethically.pdf
- https://jme.bmj.com/content/46/1/3
- https://hospicecare.com/policy-and-ethics/ethical-issues/essays-and-articles-on-ethics-in-palliative-care/the-ethics-of-foregoing-treatment-at-the-end-of-life/
- Newborn Care and “Lethal” Prenatal Diagnoses, Tracy Winsor and Bridget Mora. Ethics and Medics, January 2020.
https://static1.squarespace.com/static/5e3ada1a6a2e8d6a131d1dcd/t/5e8355c8539b7e45e8373b7e/1585665480707/EM_Jan2019_REV.pdf
- https://www.perinatalhospice.org/
