Fred at Stone Court has a good post today on the constraints placed on pregnant women. He discusses the removal of Bendectin - an anti-nausea medication - from the American market after massive and apparently wrong-headed lawsuits alleging it causes birth defects, but also notes the almost-hysterical reaction to alcohol use in pregnancy and the generally restrictive climate that pregnant women enter into.

[T]he general impulse to avoid any risk to the fetus, no matter how remote, regardless of the cost to the mother, no matter how severe, both causes substantial unnecessary suffering for pregnant women and reinforces an ideology that, once they become pregnant, women exist for their children rather than for themselves.

In my view, promoting a more realistic understanding of the risks of pregnancy is an important feminist issue.

“More realistic understanding” of anything is certainly a good idea, feminist or not. But I think he is right that the general issue of the obligations women take on in pregnancy to constrain their own lives - or even endanger them, often enough - in favor of fetal health is an important issue in feminism, and in bioethics generally. This is related to what has been known in bioethics as “maternal-fetal conflict”, but that issue has usually been construed in the most dramatic terms, where a woman’s life can only be saved at the cost of risk to or the death of the fetus. The idea that pregnancy itself is a “maternal-fetal conflict” - that being pregnant imposes risks and discomforts on women that can only be alleviated by imposing some risk to the fetus, and that the avoidance of all risk to the fetus imposes increased risks on the pregnant woman - has not generally been acknowledged.

It cannot be true that a woman surrenders herself entirely to her fetus for so long as she chooses to continue a pregnancy - yet there is little or nothing in our treatment protocols, and certainly not in our public understanding of pregnancy, that recognizes this. There is a concept of “acceptable risk” to the fetus, but it is usually invoked in the case of treatments intended to correct fetal abnormality or prolong in-utero development - that is, with regard to procedures performed on the pregnant woman for the benefit of the fetus. There is certainly no such concept that embraces treatments or behaviors undertaken by the woman for her own benefit, at some increased risk to the fetus. Yet it is a logical triviality that - even granting that the fetus is a moral person with rights or interests to advance - the calculus of interests works both ways, and the woman’s are at least as real and valid as those of the fetus.

Saying that there are such interests and they logically stand in the balance against the fetus’s does not take us very far down the road to a solution. The problem is a difficult one - it cannot be solved by appeal to an adversarial resolution of priorities, as most such “interests in conflict” cases (scarcity of resources, trumping rights, etc.) are resolved. For one thing, the primary interest of both the fetus (if such language makes sense) and the pregnant woman is the same: a healthy term pregnancy. It is only within the “margins for error” of that interest - the small risks one might take in pursuit of a larger goal - that the conflict between fetus and woman arises: may she take one glass of wine in her 8th month?; may she go skydiving? Many women willingly give up small needs or indulgences in favor of fetal health - many go to extraordinary lengths, and take great risks with their own health, to have a healthy child. But how great a sacrifice is necessary? How great is obligatory?

If taking a certain medication in pregnancy lowers the eventual child’s IQ by 10 points, is it terrible to do so to save the mother’s life? To reduce significant pain? Simply to make her feel more comfortable? Would it be worse if she merely ate some gourmet food that had the same effect, because she enjoyed it? If a 10-point drop in IQ is not a tragedy (and I submit that it is not; no matter how high or low your IQ was to begin with, a small deviation from that is not a major difference - leaving aside the question whether IQ means anything to begin with), what is wrong with doing any of these things?

What about a 50-point drop in IQ? If it is not a tragedy to be born with normal IQ, what is wrong with doing something that reduces a potential genius to the level of the average person? If there is nothing wrong with being severely mentally handicapped, what is wrong with doing something that reduces an average person to the level of a severely handicapped one?

Is it a moral transgression against your children not to give them maximal advantages or capacities? Is it immoral to treat yourself better than you treat your children? I take it as read that almost everyone would be aghast at any one of the above examples, and would answer “Yes” to both of the last two questions - but why?