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Massachusetts Medical Society




We are seeing the beginning of an alliance between physicians and the state to force pregnant women to follow medical advice for the sake of their fetuses. No irreversible commitments to such an alliance have yet been made, but only a principled discussion of the issues is likely to prevent forced treatment from becoming standard medical practice.

In her futuristic novel The Handmaid's Tale, Margaret Atwood envisions a world in which physicians and the state combine to strip fertile women of all human rights. These women come to view themselves as "two-legged wombs, that's all; sacred vessels, ambulatory chalices." To some that future is now. Typical "surrogate mother" contracts, like the one Mary Beth Whitehead signed, require the pregnant woman to follow all "medical instructions" and "not smoke cigarettes, drink alcoholic beverages, use illegal drugs, or take non-prescription medications or prescribed medications without written consent from her physician." When Ms. Whitehead refused to relinquish her child, another physician testified at trial that she was simply a "surrogate uterus." The judge himself declared the contract legally enforceable, in part because he viewed surrogacy as a mechanistic means to an end, a "viable vehicle" for infertile couples to "have a family." Some physicians also applauded the attempted criminal prosecution of a California woman for failure to follow her physician's advice during pregnancy. And in this issue of the Journal, Kolder et al. report that almost half the heads of fellowship programs in maternal–fetal medicine support involuntary detention of pregnant women whose behavior endangers their fetuses; more than a quarter advocate "state surveillance" during the third trimester to protect fetuses. Some obstetricians have already sought court orders to force various interventions on their pregnant patients.


From The New England Journal of Medicine, George J. Annas, Protecting the Liberty of Pregnant Patients, Volume 316, Page 1213, Copyright ©(1987) Massachusetts Medical Society. Reprinted with permission.

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