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Introduction

Advances in reproductive rights and judicial intervention have intensified ethical dilemmas in late-term pregnancies. When courts permit termination of viable foetuses, doctors must balance legal mandates, maternal autonomy, foetal interests, and their professional duty to preserve life.

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Ethical Dilemmas Faced by Medical Practitioners

• Mother vs Foetus: Doctors must balance the pregnant woman’s autonomy and health against the life prospects of a viable foetus.
  Eg: In the recent Supreme Court case, termination at 28 weeks involved a viable foetus capable of being born alive, creating competing obligations towards both mother and child.
• Law vs Judgment: Medical practitioners may disagree with legal directives based on their clinical assessment.
• Autonomy vs Care: Respecting informed patient choice may conflict with a doctor’s duty to act in the patient’s and fetus’s best interests.
  Eg: Under the Medical Termination of Pregnancy (Amendment) Act, 2021, maternal decision-making is recognised, yet doctors may believe continuation better preserves life.
• Life vs Suffering: Preserving foetal life may lead to severe disabilities and prolonged suffering, raising ethical concerns about quality of life.
  Eg: AIIMS informed the Court that the child could face serious medical complications, co-morbidities, and disabilities if delivered at 28 weeks.
• Integrity vs Duty: Doctors’ ethical convictions may conflict with institutional and judicial obligations.

Specific Ethical Issues in Late-Term Viable Foetus Cases

• Viability Question: A viable foetus possesses an independent chance of survival, making termination ethically complex.
  Eg: Medical literature recognises survival prospects for foetuses beyond 24-28 weeks with neonatal support.
• Neonatal Burden: Doctors must decide whether preserving life justifies potential lifelong medical suffering.
• Patient Identity: Determining who the primary patient is becomes ethically contested.
  Eg: Principle of Non-maleficence raises the question—should harm be minimised for the mother, the foetus, or both?
• Resource Ethics: Preserving extremely premature infants may require substantial medical resources.
  Eg: Neonatal intensive care for preterm births involves prolonged treatment in government tertiary hospitals.
• Legal Precedent: Judicial decisions in exceptional cases may influence future medical decision-making.

Way Forward

• Ethics Panels: Institutional ethics committees should assist doctors in difficult viability-related decisions.
• Clear Protocols: Uniform national guidelines are needed for late-term pregnancies involving viable foetuses.
  Eg: Detailed protocols under the MTP Act, 1971 (as amended in 2021).
• Board Strengthening: Medical Boards should provide timely and evidence-based recommendations.
  Eg: State-level Medical Boards already assess complex termination requests under MTP provisions.
• Shared Decisions: Decision-making should integrate judicial, medical, and patient perspectives.
• Child Support: Where viable births occur, robust neonatal and disability support systems should be available.
  Eg: Support through Rashtriya Bal Swasthya Karyakram (RBSK) and government disability welfare schemes.

Conclusion

Late-term termination cases involving viable foetuses present profound ethical challenges without easy answers. A balanced approach combining maternal autonomy, medical expertise, judicial sensitivity, and the principle of preserving life is essential for ethically sound outcomes.

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