Understanding feticide: An analytic review
Introduction
The medical procedure of feticide is a relatively new clinical procedure, emerging during the early to mid 1990s in the UK. Whilst it may be used in other circumstances related to termination of pregnancy (TOP),1 the developing academic debate around feticide focuses on feticide prior to TOP for fetal abnormality, and, in particular, where fetuses are delivered vaginally by induction of labour. Consequently, the commentary surrounding feticide has evolved around the problem of coping with the possibility that late TOP for fetal abnormality may result in a liveborn infant. In these circumstances, feticide is used to ensure that the fetus is dead before labour is induced, preventing the possibility of signs of life at birth. On the basis of publicly available data, it is difficult to establish how many feticides are performed annually for this specific purpose, but a conservative estimate would be between 300–600 (Graham, Mason, Rankin, & Robson, 2006).
In the literature, the topic of feticide has been discussed with reference to uncertainty within the medical profession about the legal status of a live birth following TOP. One important contribution to this debate is explicit guidance from professional organisations. A 1996 Royal College of Obstetricians and Gynaecologists document (RCOG, 1996, p. 15) refers to feticide being performed at gestations over 21 weeks, but this was later clarified in 2001:
The guidance appears to be impacting upon clinical practice, as Wyldes and Tonks (2007) note that the proportion of TOP for fetal abnormality resulting in a live birth has decreased after 22 weeks gestation. However, concerns about the role of professional discretion and the issue of professional vulnerability have been raised. For example, De Crespigny and Savelescu (2002), Wicks, Wyldes and Kilby (2004) and Vadeyar, Johnston, Sidebotham and Sands (2005) have highlighted the problem of legal uncertainty and variation in professional practice. More recently, Statham, Solomou, and Green's (2002) findings on late TOP highlight the difficulties that health professionals face in making decisions about providing (or not providing) feticide and working within the law. Feticide has also attracted consideration as part of the broader discussion about life and death at the edge of viability in pregnancy/neonatal care (see Nuffield Council on Bioethics, 2006). But it is difficult to contextualise these perspectives on feticide, because there is so little research that focuses on the phenomenon itself. Conversely, the issue of TOP in general has generated a substantial body of research literature in both medicine and the social sciences (see, for example, Benson, Clark, Gerhart, Randall, & Dudley, 2003; Lee, 2003; Oaks, 2003; Harden & Ogden, 1999; Simonds, Ellertson, Springer, & Winikoff, 1998; Sheldon, 1995). This research scrutiny suggests that the broader issue of TOP continues to hold significant attention; and yet, attempts to locate feticide in its social context are rare. There is little existing empirical work, and a lack of theoretically driven analysis. This leaves commentators with little research knowledge about feticide as a social phenomenon, to incorporate into or inform their evaluations. In particular, there is little knowledge about how participating in feticide is conceptualised or experienced by those most closely involved—parents and health professionals.For all terminations at gestational age of more than 21 weeks and 6 days, the method chosen should ensure that the fetus is born dead. This should be undertaken by an appropriately trained practitioner. Intracardiac potassium chloride is the recommended method and the dose should ensure that fetal asystole has been achieved.
(RCOG, 2001, http://www.rcog.org.uk/printindex.asp?PageID=549&Print=Yes)
The fragmented discourse around the concept of feticide stems from four kinds of academic discourse. First is a substantial body of literature on technical/clinical aspects of feticide as a procedure. Second, there is a discourse on the broader issue of fetal killing as a social trend. Third, there is a literature on feticide as a medical procedure that suggests a more informed understanding of its social context, but falls short of a systematic analysis of that context. These three sources provide an explicit discourse on feticide, demonstrating the multiple understandings of the concept. Finally, there is a literature centred around TOP for fetal abnormality. Feticide is a recurring theme in this literature (rather than a specific focus), providing an embedded discourse on feticide. Together, these fragments represent (i) a public repository of knowledge around an important social issue, and (ii) a source of expert information and insight for those providing services in the area. Here we give an overview of the discourse on feticide in this material, and aim to provide a more socially informed perspective on feticide. We pay particular attention to understandings of professional discretion in the embedded discourse on feticide, and argue that further research (underpinned by an adequate understanding of the social and epistemological context of the concept of feticide) is needed to inform such debates.
Section snippets
A medical perspective: feticide as a descriptive concept
The procedure of feticide emerged in the context of antenatal care and diagnosis of severe fetal abnormality. Issues of fetal abnormality had been a key focus within obstetric care since the advent of ultrasound in the 1960s (Statham, 1992), but two key factors converged in the early 1990s which brought feticide into focus. First, prenatal diagnostic techniques became more sophisticated (Wyatt, 2001), allowing more accurate and wide-ranging diagnoses of both severe and more minor fetal
Conclusion: taking feticide seriously
The concept of feticide may appear straightforward, but we have argued in this paper that it represents complexity, both from an epistemological and a substantive point of view. From an epistemological point of view, the multiple meanings of this concept demonstrate that the concept of feticide has been used to represent different layers and definitions of fetal killing. At times, the term ‘feticide’ has been used to convey particular political or ethical connotations, rather than simply to
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2011, Social Science and MedicineCitation Excerpt :Furthermore, the wall of silence surrounding feticide in Israel contributes to the informants’ ongoing doubts concerning the moral justification of their decision. Feticide represents an important part of clinical practice at the interface between life and death in health care settings (Graham et al., 2008). It further incorporates social, moral and psychological layers, all of which are evident in the informants’ stories.
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