Defense Date


Graduation Date

Spring 2009


Immediate Access

Submission Type


Degree Name



Health Care Ethics


McAnulty College and Graduate School of Liberal Arts

Committee Chair

Gerard Magill

Committee Member

Aaron Mackler

Committee Member

Rhonda Hartman


covenant, pregnancy, cesarean section, maternal-fetal conflict


Maternal-fetal conflict refers to a perceived incompatibility between the interests of a pregnant woman and her fetus. Maternal-fetal conflict occurs when a pregnant woman declines a medical treatment or procedure that her physician believes is necessary to benefit her fetus. In some situations, the pregnant woman's health is also at risk. The question explored in this dissertation is: what is the pregnant woman's moral obligation to her fetus when a cesarean section is recommended to save the life of or to prevent serious harm to her term viable fetus? The pregnant woman's life is not endangered.

Inconsistencies exist between normative theories and approaches to resolving maternal-fetal conflict. Legally, the pregnant woman's liberty rights allow her to accept or refuse treatment for her and/or her fetus. But states have an interest in protecting the potential life of the fetus even though it is not a person with rights under the United States Constitution. Philosophically, inconsistencies exist between the principles of justice and respecting the pregnant woman's autonomy and the principles of beneficence and nonmaleficence, along with the pregnant woman's duties to her fetus as her future child. Professionally, medical organizations support respecting the pregnant woman's autonomy and treating the pregnant woman and her fetus as one patient. However, some physicians favor beneficence toward the fetus and view the pregnant woman and fetus as two separate patients. Obstetricians are increasingly performing cesarean section as an elective alternative to vaginal delivery. From the religious perspective, Catholicism, Judaism, and Islam differ in their moral teachings on the status of the fetus as a person.

The pregnant woman can adopt a hermeneutical stance that gives depth of meaning to her autonomous decision based on normative theories and approaches. The pregnant woman can interpret her developing relationship with her fetus throughout her pregnancy as a covenant relationship of gift, love, faithfulness, and fidelity. The covenant relationship is expressed in the Judeo-Christian biblical covenant relationships between God and humans. The covenant relationship can also be understood on a secular level.