Elsevier

Social Science & Medicine

Volume 66, Issue 2, January 2008, Pages 289-300
Social Science & Medicine

Understanding feticide: An analytic review

https://doi.org/10.1016/j.socscimed.2007.08.014Get rights and content

Abstract

The medical procedure of ‘feticide’ has been used in clinical practice since the early 1990s in the UK. The procedure constitutes a sensitive aspect of late termination of pregnancy (TOP), an issue that is in itself contentious. The procedure has attracted attention from academic and policy commentators, but recently the medical profession has expressed some uncertainty with respect to the legal position of live birth following TOP, and professional discretion in providing feticide. To understand the meaning of these comments better, we argue that it is helpful to acknowledge the rhetoric that shapes the academic discourse on feticide. In this paper, we review how feticide has been conceptualised within academic discourse, demonstrating that the concept has multiple meanings, some of which could be considered politically charged. We then consider some examples of the comments made about the legal uncertainties of feticide, highlighting assumptions made about the problematic nature of professional discretion. Ultimately, we suggest that a better understanding of the context of feticide is needed to ensure that future research in this area of health care engages adequately with issues of professional discretion.

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:

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 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.

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

References (80)

  • C. Williams

    Framing the fetus in medical work: Rituals and practices

    Social Science & Medicine

    (2005)
  • L. Abramsky et al.

    What parents are told after prenatal diagnosis of a sex chromosome abnormality: Interview and questionnaire study

    British Medical Journal

    (2001)
  • A. Asch

    Prenatal diagnosis and selective abortion: A challenge to practice and policy

    American Journal of Public Health

    (1999)
  • K. Askey et al.

    Termination for fetal defects: The effect on midwifery staff

    British Journal of Midwifery

    (2001)
  • M. Barrazotto

    Judicial recognition of feticide—usurping the power of the legislature

    Journal of Family Law

    (1986)
  • J. Bosma et al.

    Late termination of pregnancy in North Holland

    British Journal of Obstetrics and Gynaecology

    (1997)
  • R. Boyle et al.

    An ethical approach to giving couples information about their fetus

    Human Reproduction

    (2003)
  • E. Campbell

    Theorising the evidence on discretionary decision making: Alternative perspectives

    Evidence and Policy

    (2005)
  • F. Chervenak et al.

    Is third trimester termination justified?

    Ultrasound in Obstetrics and Gynecology

    (2003)
  • F. Chervenak et al.

    Is third trimester abortion justified?

    British Journal of Obstetrics and Gynaecology

    (1995)
  • F. Chervenak et al.

    Third trimester abortion: Is compassion enough?

    British Journal of Obstetrics and Gynaecology

    (1999)
  • L. De Crespigny et al.

    Is paternalism alive and well in obstetric ultrasound? Helping couples choose their children

    Ultrasound in Obstetrics and Gynecology

    (2002)
  • Department of Health (2003). Statistical bulletin: Abortion statistics, England and Wales, 2002....
  • Department of Health (2004). Statistical bulletin: Abortion statistics, England and Wales: 2003....
  • Department of Health (2005). Statistical bulletin: Abortion statistics, England and Wales, 2004....
  • Department of Health (2006). Statistical bulletin:Abortion statistics, England and Wales: 2005....
  • M. Dommergues et al.

    The reasons for termination of pregnancy in the third trimester

    British Journal of Obstetrics and Gynaecology

    (1999)
  • M. Dommergues et al.

    Feticide during second- and third-trimester termination of pregnancy: Opinions of health care professionals

    Fetal Diagnosis and Therapy

    (2003)
  • H. Drake et al.

    Attitudes towards termination for fetal abnormality: Comparisons in three European countries

    Clinical Genetics

    (1996)
  • T. Evans et al.

    Street-level bureaucracy, social work and the (exaggerated) death of discretion

    British Journal of Social Work

    (2004)
  • J. Everett

    Indian feminists debate the efficacy of policy reform: The Maharashtra ban on sex-determination tests

    Social Politics

    (1998)
  • J. Fletcher et al.

    Fetal intracardiac potassium chloride injection to avoid the hopeless resuscitation of an abnormal abortus: II. Ethical issues

    Obstetrics and Gynecology

    (1992)
  • M. Garel et al.

    Ethical decision-making in prenatal diagnosis and termination of pregnancy: A qualitative survey among physicians and midwives

    Prenatal Diagnosis

    (2002)
  • C. Geerinck-Vercammen et al.

    Coping with termination of pregnancy for fetal abnormality in a supportive environment

    Prenatal Diagnosis

    (2003)
  • S. Gevers

    Third trimester abortion for fetal abnormality

    Bioethics

    (1999)
  • R. Gillon

    Is there a ‘new ethics of abortion’?

    Journal of Medical Ethics

    (2001)
  • C. Gleeson et al.

    Selective feticide in twin pregnancies: An exploration of parents’ experiences

    Journal of Obstetrics and Gynaecology

    (2005)
  • Graham, R., Mason, K., Rankin, J., & Robson, S. (2006). Parent and staff reactions to feticide prior to termination of...
  • M. Gross

    After feticide: Coping with late-term abortion in Israel, Western Europe, and the United States

    Cambridge Quarterly of Healthcare Ethics

    (1999)
  • M. Gross

    Abortion and neonaticide: Ethics, practice, and policy in four nations

    Bioethics

    (2002)
  • Cited by (19)

    • Silenced voices: Israeli mothers' experience of feticide

      2011, Social Science and Medicine
      Citation 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.

    • Late termination of pregnancy and foetal reduction for foetal anomaly

      2010, Best Practice and Research: Clinical Obstetrics and Gynaecology
      Citation Excerpt :

      For all terminations at gestational age of more than 21 weeks and 6 days, the method chosen should ensure that the foetus is born dead and the foeticide must be conducted by a trained doctor in foetal medicine.44 On the basis of publicly available data, it is difficult to establish how many foeticides are performed annually for this specific purpose, but a conservative estimate would be between 300 and 600.45 The RCOG recommend the use of an intracardiac injection of KCl followed by the confirmation of foetal asystole after 30–60 min.18

    • Invisible labours: The reproductive politics of second trimester pregnancy loss in England

      2024, Invisible Labours: The Reproductive Politics of Second Trimester Pregnancy Loss in England
    • Understanding baby loss: The sociology of life, death and post-mortem

      2023, Understanding baby loss: The sociology of life, death and post-mortem
    View all citing articles on Scopus
    View full text