Ethical Dilemmas Related to Foetal Diagnosis and Foetocide

Ethics is an essential dimension of obstetrics and gynaecology and helps balance beneficence and autonomy-based obligations with professional conscience ensuring respect for the pregnant woman’s autonomy. The Law defines what can be offered in our country and guides the obstetrician as well as the parents. In South Africa termination of pregnancy is legal. A woman can request termination of her pregnancy up until 12weeks if she chooses so. The South African law allows termination of a pregnancy up to 20weeks and beyond 20weeks if there are significant reasons for this to be requested or offered. The question of what foetal abnormalities are considered significant and therefore should be considered for termination has led to ongoing discussions and debates in various levels of medical and legal societies. The obstetrician has the right to exercise his or her own autonomy in dealing with these situations. Exercise of autonomy by a patient cannot justifiably oblige a physician to act in a way that is unacceptable as a matter of his/her individual conscience. Citing case laws, the Courts in the country are asked to decide on “wrongful birth”- which would require a Court to determine whether a child should have been born. The South African Constitutional Court in a recent ruling determined that "this goes to the heart of what it is to be human, something that should not be asked of the law". Medical and legal societies need to work together and help guide our doctors, our patients and society as to what is ethical and acceptable practice in complex situations where children’s genetic and structural abnormalities alone perhaps should not decide their entire destiny.