Autonomy, Moral Status, and Consequential Conundrums

At times our unreflective declarations, pronouncements, and moral positions made without adequate forethought consequentially lead to moral conundrums, with which we are then left to wrestle. A recent article entitled “The Fetus, the “Potential Child,” and the Ethical Obligations of Obstetricians,” in Obstetrics and Gynecology exemplifies an effort to reframe just such a conundrum. In this article, the authors attempt to justify a physician’s obligation to deny maternal requests that jeopardize her unborn child without rationally jeopardizing her right to abort the unborn child if she so chooses. Secondarily it addresses the issue of how an obstetrician is to define his or her moral responsibility to a being in utero.

Quickly setting aside the issue of abortion, which is stated to be grounded on the essentially unassailable right to bodily integrity (“negative” autonomy) and supported by “mainstream” ethical opinion, the issue of “positive” autonomy is addressed: are there limits on the right of a woman to demand treatment that negatively impacts her child? Acknowledging that physicians also possess negative autonomy rights and consciences (defined as “professional integrity”), on what basis can a physician refuse a maternal demand for treatment or care that is not in the unborn child’s best interests? The answer: distinguish “fetus” (having “value” but no interests) from “potential child” (having anticipatory interests that will “evolve and ultimately attain at delivery”). According to the authors, the fetus has no independent moral status because the issue is “irresolvably disputable,” confirming the arbitrary nature of that determination. So what is it that determines this distinction in moral status? Maternal choice. By the decision to eschew abortion and continue the pregnancy a woman grants moral standing to the child within while simultaneously constraining and limiting her own affirmative autonomy. This decision also enables the physician to resume the fiduciary role to the unborn that has traditionally been entailed in the care of pregnant women.

And so in an attempt to keep previous moral proclamations from overflowing their banks and being carried to their logical conclusions—conclusions which would invalidate our standing as providers of obstetrical care–they are shored up by creating new categorical boxes. But as I am so fond of saying these days, flesh and bones do not fit into boxes without remainder; embodied life is not that simple. Having created the box labeled “potential child” it is then poked full of “subjunctive” holes that make room for contingencies: “the interests of the potential child might infringe on a pregnant woman’s right…”; and “as those interests (of the fetus) rise to a level at which they can be considered…” Oh, what tangled webs we weave!

Life is fragile; and from this particular perspective, so is our moral standing as human beings, contingent as it is upon the good graces of those upon whom we are relationally dependent. Our moral agency becomes not something inherent in our nature as beings created in the image of God, but a goal to be attained–not by any act of our own but by the circumstantial whims of another.

Treating the concept of moral standing with irreverence has greater implications for other vulnerable humans as well, dependent as they often are on the grace of others for their care. Their moral standing is also now jeopardized, hanging in the balance.

And so we must return to the basic questions, as difficult and painful as they might be: What is the source and meaning of our moral standing? Who has the authority and right to determine the moral standing of another human being—and on what moral ground?

In playing with the concept of moral agency, we play with our human nature and identity; and we do so to our own detriment. In our efforts to distinguish grounds for granting degrees of moral status to the unborn in order to support our own changing personal and political agendas, we dehumanize ourselves. Moral agency has become so capricious, arbitrary, and contingent as to be meaningless.

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