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J Med Ethics doi:10.1136/medethics-2012-101258
  • Clinical ethics
  • Paper

Homebirth and the Future Child

Press Release
  1. Julian Savulescu
  1. 1Melbourne, Victoria, Australia
  2. 2Faculty of Philosophy, The Oxford Uehiro Centre for Practical Ethics, Oxford, UK
  1. Correspondence to Professor Julian Savulescu, Faculty of Philosophy, The Oxford Uehiro Centre for Practical Ethics, 16/17 St Ebbe's St, Oxford OX1 1PT, UK; julian.savulescu{at}philosophy.ox.ac.uk
  • Received 26 November 2012
  • Revised 18 July 2013
  • Accepted 22 July 2013
  • Published Online First 22 January 2014

Abstract

Debate around homebirth typically focuses on the risk of maternal and perinatal mortality and morbidity – the primary focus is on deaths. There is little discussion on the risk of long-term disability to the future child. We argue that maternal and perinatal mortality are truly tragic outcomes, but focusing disproportionately on them overshadows the importance of harm to a future child created by avoidable, foreseeable disability. The interests of future children are of great moral importance. Both professionals and pregnant women have an ethical obligation to minimize risk of long-term harm to the future child; harm to people who will exist is a clear and uncontroversial morally relevant harm. The medical literature does not currently adequately address the risk of long-term disability, which is at least as relevant as other outcomes.

The choice of place of elective birth (home, hospital or other) may only justified if it does not expose the future child to an unreasonable increased risk of avoidable disability. Doctors' duty of care for the life of the pregnant woman and her fetus may be overridden by the woman's choices. But further research is required to document the prevalence of long term avoidable disability associated with different birth place choices. Couples should be informed of this risk and doctors should attempt to dissuade couples when they elect a place of birth that puts the health and well-being of the future child at risk

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