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Abstract

The complexity of the simple term “fetus” cannot be overstated. While the biological deﬁnition is straightforward, disagreement about almost everything else surrounds the term. Religions clash over the conceptual meaning of fetal personhood, and persons have joined or left faiths because of the prescribed religious doctrine. Arrest and incarceration have taken place when the perceived fetal person has come to harm. Misguided fanatics who believe in fetal personhood have taken the lives of those who do not. Government elections have been won or lost based upon the candidate’s perception of fetal personhood. Women argue for the right to carry to term fetuses/pregnancies that they wish to parent and have marched, fought, and died to end those which they do not. Personal ﬁnances and national and state policy determine the ease or complete lack of access, to ending a pregnancy safely under sterile medical conditions. The movement to recognize the fetus as a legal person grew with the viewing of fetal ultrasounds, in which an entity within the woman’s body, previously mysterious, became visible. There is a wide range of debate when attempting to reconcile the personhood of a fetus with the fundamental rights of a pregnant woman.

Introduction

This entry will deﬁne the fetus, discuss the concept of fetal personhood, and delineate religious responses. Legal and ethical discussion will follow.

Historical Development

The fetus historically came into greater signiﬁcance with the advent of pregnancy ultrasound. Prior to this, the time of quickening, the ﬁrst fetal movements at about 17 weeks gestation, let the existence of a fetus be known. It is of historical interest, as depicted in Fadiman’s (1995), From Danger to Dignity, that in the movement in the United States for legalized abortion, the historical debate was around the health and privacy rights of women and did not center on the fetus or pregnancy itself. But with ultrasound, the fetus’s shape, size, body parts, gender, and movements became visible. With this, some women and their families began to attribute a personality to the fetus. A desired fetus might be named and a relationship be developed. A pregnancy that a woman did not wish to parent was most often ended prior to this visualization.

Conceptual Clarification/Definition

A fetus is created after the union between male (sperm) and female (ova) gametes. The gametes join and begin cell division, creating a blastocyst, then zygote, then embryo. The embryo begins organogenesis and after 12 weeks is considered a fetus. This organism continues to be called a fetus until birth occurs, usually 38 weeks after the union of the gametes. Presently, the fetus cannot live outside of the body of a woman, although the embryo can. Also, attempts have been made to allow fetuses to continue to develop within the bodies of women declared brain dead (Catlin and Volat 2009).

The attribution of personhood to the fetus is not considered part of the biological deﬁnition; rather, it is considered a conceptual or philosophically driven term. Philosophers such Fletcher and Warren have deﬁned what it means to be a person. These writers state that to be a person, one must have self-awareness; a sense of the past, present, and future; the capacity to relate, interact, and communicate with others; and curiosity and responsiveness to others. Secular philosophers generally do not accept the fetus to have these attributes while in utero and therefore do not consider the fetus to own a personhood. Philosophers coming from a religious tradition may view this in an alternative manner. Noonan, for example, deﬁnes personhood as one owning genetic human code, which occurs at conception, and contains the biologic possibility of Warren and others’ deﬁnition above.

Religious And Cultural Influence On Definition Of Fetus

Religion or tradition may deﬁne the meaning of fetus and acceptance of attributes of fetal personhood for each individual. Not everyone looks to religious faith or biological deﬁnition to deﬁne personhood. For some it is an innate connection to the growing fetus that occurs at the ﬁrst knowledge of the pregnancy. Due to the technological advances in fetal ultrasonography, a woman can choose to view, monitor, and name the fetus and mourn it if lost. Additionally, the values that an individual woman holds may not be in keeping with the ofﬁcial teachings of her religion or the cultural norms reported by other members of the same culture (Srikanthan and Reid 2008).

Usually religious deﬁnitions come from words from ancient texts of holy books for each particular faith. How the passage is interpreted may relate to the level of orthodoxy and adherence to the faith that an individual holds, with the more orthodox of a faith adhering directly to the texts. Examples will be given below.

In Islam the fetus is said to be “ensouled” after 120 days or the 17th week. This guidance comes from the Shari’a in the Holy Quran. Most scholars agree that prior to that time a pregnancy may be ended for fetal anomalies or threat to a woman’s health. The Shari’a is supposed to be ﬂexible and to adapt to potential complexities with the general goal of guidance to prevent harm. If a threat exists to the woman’s life or the fetus dies in utero, the fetus may be removed after 120 days.

In Islam there are two differing positions on the sharing of fetal or fetus making materials. In the Sunni faith, there is “no mixing of genes, no sperm donation, no egg donation, no embryo donation, and no surrogacy” allowed. In the Shi’ite guidelines, the rules are less rigid and more open to allowing families to seek reproductive assistance to create a gestating fetus (Serour 2013).

Islamic tradition assigns importance to a fetus taking at least one breath after birth. With this breath the fetus/infant can be assigned the azan prayers, and should the fetus/infant die, it can be buried in a Muslim cemetery. When the infant does not take a breath after birth or there is no one present to give the assigned prayer, the fetus is not considered a person and cannot be traditionally buried.

Judaism

In Judaism, the fetus is considered a living organism situated within a woman’s body and gains respect as it moves to the latter weeks of gestation. A passage out of Exodus 21: 22–23 is used to differentiate between a fetus and a person in Jewish law. The passage states that if a pregnant woman is injured and the fetus killed, this is not a crime akin to murder. In the ﬁrst 40 days of gestation, pregnancy termination is allowed by all levels of Judaism, Orthodox through Reform, using the Talmudic statement Yevamot 69b that in the ﬁrst 40 days the embryo is “mere water” (Schenker 2013). For Reform Judaism, ending a pregnancy is not to be taken lightly, but is allowed at any stage if it is for the woman’s life or family or community well-being. Originally, the newborn child was not to be a viable person until it had survived 30 days following birth, as is stated in the Talmud Numbers 18:16. In more modern times, the fetus does not become a “person” until its “greater part” is delivered and it draws breath. Personhood is attributed at the naming or circumcision on the 8th day of life.

Eastern Faiths

In Buddhism, a fetus is considered to be a reincarnated person. Birth, when viewed from a Buddhist perspective, encompasses the state in which people can choose the families to which they will be born and what life experiences they will have. Relationships with a fetus center on good intention; a woman may relate positively to the fetus from the moment of conception. She may also terminate the pregnancy should something negative occur, such as illness, rape, or economic hardship (Srikanthan and Reid 2008). In Chinese religious traditions of Confucianism and Taoism, harmony and peace are sought (Srikanthan and Reid 2008). This does not seem to coincide with the social issue of ending pregnancies after one birth in China (Nie 2002). For those in the Hindu faith, Karma is the goal – one reaps what one sows (Srikanthan and Reid 2008). Generally, there is ﬂexibility in the Hindu doctrine and freedom of choice. Conception is considered when life begins, and termination of pregnancy is discouraged but not forbidden (Srikanthan and Reid 2008).

Catholicism

In Catholicism and the more fundamental Protestant faiths, the fetus is considered as a human person from the moment of conception. This interpretation (Sullivan 2003) comes from Biblical sources such as Psalm 139:13–16 in which “God know(s) the person within the womb.” The deﬁnition was reafﬁrmed in the Catholic Donum Vitae (1987): “The human being is to be respected and treated as a person from the moment of conception; and therefore from that same moment his rights as a person must be recognized, among which in the ﬁrst place is the inviolable right of every innocent human being to life.” These beliefs in the sanctity of the fetus inﬂuence national and international health policy in terms of the right to end a pregnancy. Some persons within the Catholic faith believe that if a woman’s life is endangered, the pregnancy may be ended, but many do not (see case of Sister Margaret McBride).

Protestant Faiths

The Protestant faith opinion on fetal personhood runs from never to always. For many in the faith, a woman’s health and well-being and desire whether or not to parent are personal issues. The mainstream Protestants have historically supported Roe v. Wade and also support legal abortion. Fadiman’s landmark ﬁlm presented the real-life contributions by Protestant, Baptist, and Jewish clergy to concern for the lives of women. The more fundamental of the Christian Protestants disagree with their peers and view fetal personhood as sacred, something to be fought for through protest and legislation.

Faith Impact Upon The Law

The movement to recognize the fetus as a legal person grew with the viewing of fetal ultrasounds, in which an entity within the woman’s body, previously mysterious, became visible. Forthright support for pregnancy and celebration of a developing fetus is correct for those sharing these beliefs. However, ethical issues arise when the most orthodox members of these religious faiths, by attribution of personhood to the fetus, draft and support legislations which govern the lives of those not sharing these beliefs. Christian extremists have on occasion subverted the law and resorted to violence in an attempt to prevent the destruction of the unborn (NARAL 2014). This is a uniquely American phenomenon, which is thought to be based upon faith.

Currently, there are laws which (1) refuse to allow ending a pregnancy by choice or medical necessity as in 31 % of world population [see map of world access to ending a pregnancy (Center for Reproductive Rights 2013)], (2) consider a pregnant woman to be committing homicide should she take actions considered to be secondarily attributed to fetal death (e.g., case of Jessica Marie Clyburn, who jumped out of a window in a suicide attempt and lived, but fetus died), (3) support legislation which incarcerates women who take actions which may be considered harmful to the fetus (e.g., case of Casey Gloria Allen, 12 weeks pregnant and arrested for a positive drug screen), (4) refuse to allow honoring a pregnant woman’s advance directive for withdrawing or withholding life support (e.g., see case of Marlise Muñoz, declared brain dead but not allowed to be taken off respirator), (5) do not permit a competent woman’s rejection of consent to undergo cesarean birth (e.g., see case of Rinat Dray, forced to have surgery without consent), and (6) appoint the fetus an independent lawyer to argue against the pregnant woman (as in the state of Alabama appointment of a lawyer to all fetuses under the judicial bypass of abortion law).

Social Ethical Considerations

The complexity of the woman/fetus dyad lends itself to many ethical and legal considerations. Feminist philosophers such as Purdy (1990) refuse to view the woman as a fetal container and allow that her choice to parent or not parent a pregnancy is solely her own right. Physician groups such as the American College of Obstetrics and Gynecology support a woman’s autonomy to parent or end a pregnancy, whereas the Medical Associations in El Salvador and Poland do not. Additionally, lay and religious organizations will support or deny the woman’s bodily integrity. As fetal rights are recognized and defended, charges against women for child abuse and homicide of the fetus have developed. The National Right to Life organization provides legal support for fetal personhood initiatives, whereas the National Advocates for Pregnant Women have provided legal support for maternal autonomy issues.

Where a woman is on the socioeconomic scale and where she lives in the world will determine the individual rights that she has for her body and also her accessibility to medical services. This becomes more than a philosophical issue when women are determined to end their pregnancies and no legalized, affordable medical assistance are available. The World Health Organization, in their seminal publication on the epidemic of unsafe abortion (Grimes et al. 2006), reports an estimated 19–20 million unsafe abortions take place every year with 68,000 deaths and millions of injuries, many permanent.

In an offer of support to all developing fetuses, organizations such as Heartbeat International and Birthright International offer pregnancy assistance in the form of food, medical care, and shelter for pregnant women. Adoption placements for healthy newborns are readily available. In the United States, designated “safe havens” for drop-offs of unwanted newborns have been developed. The move to support all fetus/newborns is robust and grows with political backing.

Modern Medical Issues

When prenatal diagnosis indicates that a fetus is developing with a serious and life limiting genetic or structural anomaly, medical practitioners often advise and offer ending the pregnancy. Recently, there has been a development to also offer the opportunity for the fetus to be born and the infant offered comfort and parenting for the short period of life it will live. This movement is called prenatal or neonatal palliative care and is offered with a birth plan (English and Hessler 2013), support (Wool 2013), and dignity for the infant, family, and medical team. Kuebelbeck describes this experience in her biographical text. Additionally, there are now those somewhat beyond the mainstream who argue for the right to surgically treat and parent fetuses with severe structural and developmental anomalies (Janvier and Farlow 2014). Most medical practitioners, however, who believe that such infants may need multiple hospitalizations and ongoing medical interventions, cannot meet developmental milestones, and would face ongoing suffering, prefer to offer palliative care to these families (Merritt et al. 2012). Like termination in general, these debates will surely continue, and many may continue to be faith based.

Conclusion

Kurjak et al. (2007, p. 379), in a seminal paper on deﬁning fetal personhood, attempt to work through the numerous dilemmas. They agree that “there is no common intellectual ground on which Roman Catholics, Protestants, Jews, Muslims, Hindus, Buddhists and secular philosophers could ever hope to meet.” Therefore, they attempt to discuss the fetus as a patient. Regardless of the personhood view, most would accept that a fetus can be a patient and receive attention from a physician and health-care team. Some look for a balance between what the woman believes is the best thing for herself, her loved ones, and her community and what might be believed as best for a fetus. Prior to what may be considered viability, about 24 weeks into gestation, the woman’s private decisions, her location, and socioeconomics often determine both fetal and maternal patient outcome. After 24 weeks gestation, some medical teams may attempt to be more directive in giving the fetal patient a more prevalent place in deliberations for care.

The concept of a “unity” view has been discussed (Schroedel et al. 2000). If a conﬂict exists, it should be reframed to a uniﬁcation theory, in which the best interests of the pregnant woman will provide the best circumstances that she can imagine for the united zygote. She will consider whether the zygote should develop or not, be gestated or not, and parented or not. There are no absolute conclusions to be drawn on this issue and no easy way to reconcile the fundamental rights of a pregnant woman with the concept of personhood for the fetus. This subject is certain to invite ongoing ethical debate in the church, the courts, women’s groups, medical practices, and society as a whole.

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