This book is arranged by the stages of pregnancy – in part because it is intended for a clinical audience, in part because the stages of pregnancy offer a narrative framework for understanding the recent debates in maternal–fetal medicine. This introduction, however, offers a different kind of descriptive framework – a conceptual one. In the second chapter, Carson Strong complements this introduction by suggesting a normative framework for use in debating issues in reproductive ethics generally, and maternal–fetal ethics in particular. (Reproductive ethics would also include other more ‘high-tech’ areas such as reproductive cloning, which are mostly omitted from this book because at present they are not immediately relevant to clinical practice, no matter how many column-inches of newsprint they occupy.)

Judging by the interests of the authors collected here, who come from a wide international and professional range of backgrounds, recent ethical debates in maternal–fetal medicine can be grouped into four principal areas:

1. Power in the obstetrician–patient relationship, and the justifiable limits of paternalism and autonomy. Another less familiar way of phrasing this tension, as Jean McHale puts it in her chapter (6), is in terms of two dominant but conflicting rhetorics – ‘choice’ versus ‘responsible parenting’.

2. The impact of new technologies and new diseases. Here IVF (in vitro fertilization) and associated fertility technologies are twinned with HIV and AIDS because in both cases developments from outside ethical theory are driving ethical debate.

3. […]

Background: why does ownership of embryonic and fetal tissue matter?

Until very recently the question of who owns embryonic or fetal tissue was of limited commercial importance, although there were applications of aborted fetal tissue in the treatment of Parkinson's disease, diabetes mellitus and other conditions. With a few exceptions the use of embryonic tissue was, so to speak, a non-issue (Boer, 1994), although the use of ovarian fetal tissue was specifically forbidden by Parliament.

By mid-1999, however, commercial exploitation of stem cells had been termed the most controversial ethical issue in biomedicine (Capron, 1999). The threshold event occurred in November 1998, when two separate teams of US scientists claimed that they had managed to isolate human embryonic and fetal cells and grow them indefinitely under laboratory conditions. These pluripotent and/or totipotent cells are effectively the parent cells for all bodily tissues, with an unlimited capacity to divide and the theoretical potential to become any body tissue. (Some authors equate pluripotent and otipotent cells, but others distinguish between totipotent cells, at the 2–4 cell stage, which are capable of giving rise to every cell line in the body and to an entire human individual, and pluripotent cells, which are derived from the blastocyst at a slightly later stage of development, when the outer and internal cells have already become differentiated.)