The changing climate of legal and ethical issues in maternity services

A number of recent cases have highlighted the need for midwives to have an increased knowledge and understanding of legal and ethical issues and how to apply these in practice. One of these, the case of CP v Criminal Injuries Compensation Authority, has been discussed in detail in this month's legal column (p902).

It is recognised that midwives have to deal with sometimes complicated moral dilemmas, in which they may require assistance. The Nursing and Midwifery Council (NMC, 2014a: 3) state that supervisors of midwives ‘must support and work collaboratively with midwives working with complex ethical, legal and professional issues’.

So what are some of the issues a midwife might face in contemporary practice? The starting point is logically related to fetal rights. Currently, under English Law an unborn child does not have legal rights until the point of birth when it becomes a person in its own right, independent of its mother (Griffith et al, 2010). The wider and more contentious debate relates to personhood and when life begins with experts having differing opinions. Some believe that life begins at conception, others at the point of viability where a baby can survive independently of its mother, and others at the point of birth when the baby takes its first breath. In the case of CP, if the appeal is upheld, it might bring into question fetal rights: so what could the consequences of this be? To assess this, we shall discuss some cases in the US where the fetus already has a legal status. Paltrow and Flavin (2014) describe a number of scenarios where women have been arrested using these laws. In Utah, they highlight the case of a woman who gave birth to twins, one of whom was stillborn. She was arrested on a charge of fetal homicide when it was purported that the death was due to a delay in agreeing to a caesarean section.