The fetus as a patient: professional responsibility in contemporary Perinatal Medicine.

Abstract

The concept of the fetus as a patient has evolved over the past several decades, driven by advances in fetal medicine, neonatology, and bioethics. Pioneering international work by Erich Saling, Ian Donald, William Liley, L. Stanley James, and Roberto Caldeyro-Barcia transformed the fetus from a passive presence into an active subject of medical diagnosis and intervention, laying the groundwork for a dual-patient ethical model in obstetric care. The Society "The Fetus as a Patient," established in the early 1990s, galvanized international collaboration among clinicians and ethicists, promoting the recognition of the fetus as a patient. Since its inception, the Journal of Perinatal Medicine has served as the official and essential publication of the Society for the Fetus as a Patient, disseminating many of its most influential papers. Central to this evolution is the professional responsibility model, which delineates clinicians' ethical obligations to both pregnant and fetal patients, emphasizing evidence-based advocacy and beneficence while respecting maternal autonomy. The model defines the fetus as a patient when the pregnant woman seeks care and when interventions can reasonably benefit the fetus, with viability as an inflection point serving as a key ethical threshold. Technological advances in the 21st century, such as fetal surgery and gene therapy, have further advanced the ethical landscape, necessitating nuanced, preventive ethics and transparent communication. The 2009 and 2024 International Academy of Perinatal Medicine New York declarations have reinforced the global commitment to equitable, ethically sound perinatal care, balancing maternal rights and fetal interests. As maternal-fetal medicine continues to advance, ongoing ethical reflection, institutional support, and interdisciplinary international collaboration remain essential for aligning clinical innovation with professional integrity and justice in perinatal care.