Blessed are the peacemakers: commentary on making peace in gestational conflicts

Ethical considerations on methods used in abortions

There is a fundamental inconsistency in Western society's treatment of non-human animals on the one hand, and of human foetuses on the other. While most Western countries allow the butchering of animals and their use in experimentation, this must occur under carefully controlled conditions that are intended to minimize their pain and suffering as much as possible. At the same time, most Western countries permit various abortion methods without similar concerns for the developing fetus. The only criteria for deciding which abortion method is used centre in the stage of the pregnancy, the size of the fetus, the health of the pregnant woman and the physician's preference. This is out of step with the underlying ethos of animal cruelty legislation, cannot be justified ethically and should be rectified by adjusting abortion methods to the capacity of the fetus to experience nociception and/or pain.

Counselling women about choice

Patient choice-informed consent and informed refusal-is an important ethical and legal principle in medicine. In pregnancy this issue is not straightforward: should a pregnant woman's autonomous choice be respected when she may cause fetal harm by declining recommended caesarean section? Should a pregnant women be free to choose elective caesarean section as an alternative to labour and vaginal delivery? This chapter reviews cases of court-ordered caesarean, and the ethical and legal paradigms for informed refusal in pregnancy. In general, clinicians should not seek court authority to support medical recommendations. This chapter also reviews arguments for and against offering women elective caesarean without strict medical indication. Although compelling arguments in favour of caesarean on demand can be made, clear evidence showing adequate safety and advantages of elective caesarean over vaginal delivery does not yet exist. Ethics, law, politics and history all inform the issue of choice with respect to caesarean in important ways.

Sex-selective abortion: a relational approach

A critical application of Ruddick's model of maternal thinking is the best way to grapple with the ethical dilemmas posed by sex-selective abortion which I view as a "moral mistake." Chief among these is the need to be sensitive to local cultural practices in countries where sex-selective abortion is prevalent, while simultaneously developing consistent international standards to deal with the dangers posed by the use of sex-selective abortion to eliminate female fetuses.