ABSTRACT
Ongoing Challenges to Autonomy Pressures promoting intervention in pregnancy are likely to intensify in future. In the US, the potential for invoking state interests to override maternal autonomy is very much alive. In the UK, there are multiple mechanisms, in addition to questioning competence or child welfare, by which women’s compliance with medical advice might be secured. Whilst some of these concerns are, at present, purely speculative, it should be borne in mind that, repeatedly, throughout the sequence of British forced Caesarean cases, it appeared that no further such cases would arise: In Re S1 was followed by Royal College of Obstetricians and Gynaecologists (RCOG) guidelines2 which stated emphatically that judicial intervention was inappropriate, yet further cases followed.3,4 Notwithstanding the guidance given in Re MB,5 the Collins case6 still occurred. Autonomy is, as yet, far from guaranteed, and there are numerous factors that may in the coming years create increased demands for control over pregnancy by parties other than the woman involved. Pressures for a Swing in the Balance Ever more extensive and sophisticated means for imaging and testing a foetus in utero are likely further to drive the current impetus towards ‘quality control’ of pregnancy outcome. Inevitably, this will intensify pressures on women to undergo such tests and, of course, to act upon the results – indeed, some commentators have argued that the advent of such technologies has not enhanced maternal choice at all.7 Treatment options will increasingly become available, many of which may involve invasive procedures such as intra-uterine surgery – even the possibility of in utero heart transplant has been suggested.8 Extensive possibilities are being put forward for genetic testing in pregnancy; for example, a proposal for universal antenatal screening for the most common life-shortening single gene disorder, cystic fibrosis – for which one in 24 people in Britain is a carrier.9 Feitshans has pointed out that, given the unfavourable chain of precedents regarding women’s autonomy during pregnancy, the impact of new genetics technologies may require strong legislation to protect women’s rights during pre-natal care, particularly regarding adequate information, rights of refusal and confidentiality of information about prenatal prognosis.10
