Physicians typically consider the pregnant woman as one patient, while establishing dual goals of a good outcome for the woman and her fetus. However, advances in perinatal medicine have led to the concept of two separate patients by many clinicians and authors. It is now possible to intervene on the fetus and these fetal interventions are often referred to as fetal surgery. But when one intervenes on the fetus as a patient, they need to also operate on the pregnant woman [1].

The fetus does not need to be seen as a second patient to create a moral duty for the obstetrician. When a pregnant woman presents herself to an obstetrician, she implicitly establishes a link between the fetus and the child-to-be by wanting to continue the pregnancy. The pregnant woman confers the status of patient to her fetus [2]. Although this argument allows this status to be withheld in the case of abortion, it also requires persons on both sides of the abortion debate to acknowledge that, once a woman confers patient status on her fetus, the obstetrician and the mother-to-be have a moral duty to provide care for the fetus as a future child. This duty extends to the pediatrician, who can be involved in helping the future parent make good decisions for the not-yet-born child. In some circumstances, one of these decisions might be to provide palliative care when a neonate will be born with a serious condition [3].

Even if the question of the fetus as a patient is sensitive, we cannot ignore it. To deny the fetus any kind of status is troubling, especially when all prenatal screening and diagnostic tests are directed toward evaluating the fetus’s health and development. On the other hand, one can understand the risks of allowing the fetus to have its own juridical status, leading to the possible slippery slope where a pregnant woman could be neglected as a person for the benefit of her fetus.

There must be middle ground between these extremes to allow the fetus some kind of a social importance, without neglecting women’s right to be in charge of their own bodies and responsible for their fetuses. While medicine has been giving a face to fetuses through technology, it must now recognize its responsibility towards defining the status of the fetus.

So wherever the ethical delimitation of the fetus stands, it will inevitably and continually raise important ethical questions.

In many societies, the right to terminate a pregnancy represents a victory for women’s freedom and autonomy. In many countries, it is legal for women to be able to choose to pursue or not a pregnancy or to have a child. However, can this reproductive choice really compare to the choice of interrupting a pregnancy because of a fetal anomaly? In fact, the medicalization of pregnancy and materialization of the fetus through imaging and other diagnostic techniques imply that medicine has a responsibility in such a decision-making process. Several states and countries have addressed this difference by delimiting a period of time during the pregnancy where termination of pregnancy is acceptable, for example, when the fetus reaches viability.

Thus, for several societies, abortion can essentially be categorized as follows: voluntary abortion (reproductive) during the first trimester of pregnancy, abortion for fetal anomaly during the second trimester, or demarcated by the limit of viability being between 22 and 24 weeks of pregnancy. Late termination of pregnancy remains legal in many countries, at any gestation until birth and in exceptional conditions, such as when the fetus has substantial risk of severe disability and/or when the pregnancy represents a threat to the woman’s health.

The discovery of a fetal anomaly generally occurs during the second trimester of a pregnancy. A fetal ultrasound, which is routinely done during pregnancy, makes it possible to visualize fetal morphology at a relatively early stage, typically between 17 and 20 weeks. A radiologist specialized in this field or an obstetrician usually carries out this highly specialized ultrasound.

From an obstetrical point of view, the interests of the mother are primary. If she wishes to stop her pregnancy following the discovery of an anomaly and the information she has received, the obstetrician will probably agree to the request.

In Canada, in contrast with many other countries, there is no law regulating late terminations of pregnancy. Although the viability of the fetus to extra-uterine life seems to be a criterion adopted by many clinicians, any delimitation is at the discretion of the physician who will carry out the procedure. The fetus does not have any rights of its own and is in fact considered as an integral part of its mother. Legal rights, as any other person, occur at birth. As termination of pregnancy is outlined in the standards of care for women, it is often perceived as a right. And since the healthcare system covers abortions, many obstetricians often feel they are obligated to offer it and/or comply with abortion requests at later stages of pregnancy.

This dichotomy between the absence of rights of a fetus inside its mother’s womb and full citizen’s rights after the birth has led to a particular practice of termination of pregnancy after viability. Indeed, in many countries, to avoid the birth of a living child with full legal rights, it is not uncommon to carry out late abortions, or a feticide (lethal injection in the uterine cavity, the umbilical cord, or the heart of the fetus) that ensures the death of the fetus.

This practice raises particularly complex ethical questions. On the one hand, aside from considerations of rights, are there ethical differences between a later fetal euthanasia, after viability and a postnatal euthanasia? Does the “geographical” position of the fetus allow this ethical distinction? Beyond this thorny question, one foresees that without some boundaries, criteria that make it possible to decide on a late termination of pregnancy cannot be the same ones used to decide whether to systematically offer palliative care after the birth of the child. In fact, it would be medically unethical to offer palliative care to a child who only presents with a mild anomaly.