First Published in Brhat Dhiti, February 2026
PART 1
Note: This article is based on a talk presented at the annual meeting of the Indian Association of Pediatric Surgeons – AP and TS Chapter, held in Vishakhapatnam on February 1, 2026.
Antenatal diagnosis and management, commonly referred to as fetal medicine, is a rapidly evolving field within medicine. Since the 1950s, technological advancements have led to a remarkable study of fetal problems and treatment strategies. The fetus is now receiving various genetic therapies, surgical interventions, and other medical treatments for many conditions. However, alongside these advancements, numerous ethical and moral questions have arisen, reflecting the complexities of fetal medicine.
This essay will briefly examine some of the key issues. The first part discusses the evolution of ethics, while the second part explores cultural differences in understanding ethical and moral domains, using the issue of pregnancy termination as an example. The section on cultural differences draws on the remarkable work of Dr. S. N. Balagangadhara of Ghent University in Belgium.
What Are Ethics?
Ethics, often equated with morals, is a system of principles that delineates notions of right and wrong behaviour towards other humans, animals, plants, and the environment. Interestingly, ethical principles are entirely anthropocentric, reflecting purely a human perspective that prioritizes human rationality and language. As a result, except for adult humans, entities such as the environment, animals, and fetuses lack a voice in ethical discussions, leading humans to make decisions that perhaps serve their own interests rather than the greater good.
Ethics is generally studied under three broad domains. These are:
- Normative ethics
- Applied ethics.
- Metaethics
Normative ethics are guidelines that outline conduct for leading a positive life, representing universal principles applicable across cultures and times. Normative ethics assumes that “moral laws are universalizable.” An example is the statement, “It is wrong to harm a child for amusement.” This would be a normative ethic true across times and cultures.
There are three factors involved in any action: the agent, the action itself, and its consequences. Depending on the focus, there are three main ideas regarding normative ethics as propagated by various philosophers.
- Consequentialism assesses acts based on their beneficial outcomes. Utilitarianism, or the principle of the greatest good for the greatest number, notably embodies this idea. John Stuart Mill and Jeremy Bentham are generally associated with this idea of ethics.
- Deontology focuses on the agent and the agent’s intention behind the act, irrespective of the results. The deontologists would claim that telling the truth and keeping promises are important ethical principles, regardless of the consequences. Immanuel Kant is associated with this idea of ethics.
- Virtue ethics centres on the qualities of the act itself, such as courage and compassion, prioritising these qualities over both the agent and the consequences.
Applied ethics is a domain that applies ethical principles to real-life situations in diverse fields, covering topics like abortion, end-of-life decisions, animal treatment, and environmental issues. It includes various branches of ethics, such as medical ethics, professional ethics, business ethics, and so on.
Metaethics examines the foundational theories that support ethical studies. It questions the fundamental assumptions and concepts involved in the formulation of ethics. Are there any “objective” moral facts in the first place, and how is moral knowledge attainable?
There are other ideas of ethics where God or other factors come into play. The Divine Command Theory looks at God as the source of morality. Contractualists look at the social contract between humans as a source of morality, while Discourse ethics is based on rational reasoning and agrees to multiple perspectives depending on the cultural backgrounds.
Bioethics
Bioethics is a branch of applied ethics that began to develop in the latter half of the twentieth century. It addresses moral questions and issues arising in the life sciences related to human beings, animals, and the environment. Bioethics emerged as a formal discipline in the early 1970s, largely attributed to the contributions of V.R. Potter (Bioethics, the Science of Survival, 1970) and Daniel Callahan (Bioethics as a Discipline, 1973), alongside the establishment of the Kennedy Center for the Study of Human Reproduction and Bioethics. However, the origins of bioethics can be traced back to the German theologian Fritz Jahr, who, in the late 1920s and early 1930s, coined the term “Bio-Ethik” to explore ethical issues pertaining to humans and the environment.
The Nazi Human Experimentation (1942-45) was a shocking chapter of medical experimentation. The documented 15,000 human experiments by the Nazis in concentration camps, mainly on Jews, were devastating and shocking. These included painful amputations without anaesthesia for testing anticoagulants; organ removals for transplantation experiments, again without anaesthesia; hypothermia tests; sterilization via X-rays and drugs; and high-altitude experiments. Such practices, considered unethical even for animals today, prompted the establishment of a code of conduct for biological experiments. Some of the checks created in the aftermath of these revelations were the Nuremberg Code (1947). The Declaration of Helsinki (1964) is a cornerstone ethical document for human medical research, developed by the World Medical Association (WMA).
In the 1890s, Dr. Albert Neisser, famous for his venereal disease research, conducted unethical experiments by injecting syphilis serum from patients into prostitutes without obtaining their informed consent. This reflects a troubling history of controversial experiments, a pattern of behaviour that the United States has also exhibited. The Tuskegee Syphilis Study (1932-1972) stands in the annals of unethical medicine, despite all the codes and checks in place. The Public Health Service (PHS) and the CDC conducted a 40-year observational study involving 400 African American men with syphilis, without obtaining informed consent or providing treatment. The study withheld penicillin and tracked the disease’s progression to death and autopsy, resulting in over 100 deaths. A whistleblower exposed the study, triggering public outcry.
Several ethical debates have led to legal interventions in medicine. The Harvard Definition of Brain Death (1968) was the first step toward organ donation. The case of Karen Ann Quinlan (1975) explored issues of prolonged vegetative states. The “Baby Doe Rules” (1982) emerged after the parents of a Down syndrome baby refused surgery for oesophageal atresia—a condition where the food pipe is not formed adequately, resulting in the baby’s death. These rules stipulated treatment must be offered unless the infant is terminally ill or treatment is futile. The famous Roe v. Wade (1973) case and the death of an Indian dentist in an Irish hospital will be dealt with later when considering the termination of pregnancy.
The Common Ethical Problems in Fetal Medicine
Fetal medicine and interventions are probing deep into the most inaccessible parts of the fetus and offering various options to the mother and family today. However, their use has given rise to many ethical questions. As technology and interventions advance, the ethical issues grow more complex and difficult. There are many ethical questions, but a few seem pertinent in fetal medicine today.
Most importantly, fetal medicine has changed the pregnancy experience. Pregnancy has almost become a disease, and physiology has been getting converted to pathology since the emergence of antenatal screening in the 1950s. Before, the fetus was assumed to be healthy, unless there was evidence to the contrary. Now, normality has to be proven. The use of invasive techniques carries certain risks for the mother. Nevertheless, it is evident that, on the whole, technology tends to benefit the mother more than the fetus.
Testing primarily benefits pregnant women by enhancing their decision-making regarding reproductive issues. However, it can also diminish their sense of control and lead to the involvement of third parties in private matters. The fetus benefits much less from the actual treatment. A rational-economic perspective dominates today. Preventing disabilities is more financially beneficial than providing care for disabled children.
Antenatal diagnoses have expanded the definition of “unacceptable abnormality” while simultaneously narrowing the parameters of “acceptable normality”. Conditions such as Down syndrome and spina bifida are now perceived as costly, raising concerns about which other conditions might similarly be classified as “unacceptable” should economic circumstances worsen.
Diagnosis of any condition generally leads to treatment, making the patient comfortable, or non-intervention. “Life or no life” is never an option in medicine. However, in fetal medicine, abortions are a very viable option. But such an action is in whose interest? Is it in the interests of the fetus, mother, or society? There is clearly a lack of agency for the fetus in decision-making regarding its future. It is the mother or the family who makes choices. If the rationale is the severe psychological and social stress the mother faces, some ethicists maintain that female feticide and abortion for Down syndrome are morally and ethically on a similar plane.
Antenatal diagnosis and selective abortions have diminished research into treatments for rare genetic diseases, exemplified by Huntington’s chorea, a progressive neurodegenerative disorder. The practice of selective abortion lessens incentives to seek cures, resulting in considerable suffering for individuals affected by such disorders and those who lack prenatal medical intervention. The issue with fetal screening combined with selective abortion is that we cannot eradicate the disease without also eliminating the subjects affected by it.
The counseling process and the training of the counselor appear to be crucial in fetal medicine outcomes. However, there may be limited access to specialists in fetal medicine, genetics, pediatric surgery, or other allied specialities. Insufficient knowledge may hinder effective counseling, often leading families to opt for termination as part of a binary decision-making process. Counseling also poses difficulties with late-onset diseases, such as Huntington’s disease or genetic disorders characterised by variable expression. Furthermore, the ethics surrounding abortion for treatable genetic conditions, including phenylketonuria (PKU), remain a contentious issue.
So, what does the future hold? The possible directions include gene therapy for genetic disorders, medical treatment for correctable health issues, and surgical correction of structural anomalies. For example, CRISPR is a gene editing tool that is being used in diseases like sickle cell disease, beta-thalassaemia, HIV, cancer, and so on. It is useful for treating rare genetic disorders where individual research is becoming difficult. The prospect of scarless healing in fetal surgery encourages mothers to agree to invasive procedures, despite the associated risks. Nonetheless, the ethical issues surrounding these evolving practices are complex and unresolved.
Down Syndrome and Other Genetic Anomalies
Down syndrome is a prototype genetic anomaly and a target of antenatal screening technologies. World Down Syndrome Day, observed on 21 March, aims to promote opportunities and inclusion for individuals with Down syndrome (DS). Despite these efforts, the societal integration of these children with variable physical and intellectual disabilities remains difficult.
Antenatal screening for Down syndrome, a “search and destroy” mode, often leads to pregnancy terminations, exemplified by Iceland’s near 100% elimination rate of the condition. On the other hand, what is the perspective of the Down syndrome-affected children about themselves? Disturbingly, a study of 284 children over 12 years with this condition showed that almost all were happy with their lives and families, with 97% liking who they are and 96% satisfied with their appearance. Nevertheless, challenges in making friends can lead to isolation. This situation raises an ethical dilemma: while advocating for inclusion and equality, society simultaneously attempts to prevent the birth of individuals with Down syndrome.
Some ethicists argue that a fetus with Down syndrome shouldn’t be terminated. The appropriate action following the diagnosis of genetic conditions with variable expressivity presents a considerable challenge. As more diseases become identifiable through pre-delivery diagnosis, ethical dilemmas are likely to escalate in the future.
Female Feticide
This is another ethical dilemma we face in society. The PCPNDT Act, enacted in 1994, addresses the imbalance of sex ratio at birth in India due to many factors. In certain conditions affecting the fetus, knowing the gender of the fetus is crucial for prognostication. Yet, by law, the sex of the child cannot be revealed to the family. This gives rise to peculiar problems during counseling for the condition.
China and India seem to place the highest premium on male children. The reasons are many. In India, overriding factors include the desire to continue the family name, the belief that only a male child can perform last rites after death, and the notion that male children provide better care for their parents in old age. Rather than focusing on laws like the PCPNDT Act that punish doctors, education may be more effective in changing societal perceptions. In the West, it is generally accepted that parents should know the sex if desired. This is certainly a battle India has to win in the future. Governmental efforts and societal education appear to be gradually progressing.
This is a graph showing the sex ratios at birth across the world. China and India have the most skewed ratios.
PART 2
Cultural Differences In The Moral And Ethical Domains
Almost all ethical issues and philosophies seem to come from a Western perspective. There are significant cultural differences in the understanding of the ethical and moral domains. India is a 5000-year-old civilization with an extraordinary body of literature in both Saṃskṛta— and vernacular languages, encompassing nearly all aspects of the material and spiritual realms. It is remarkable that a civilization that has produced some of the most profound philosophical systems, or darśanas, such as Nyāya, Vaiśeṣika, Yoga, Sāṃkhya, Mīmāṃsā, and Vedānta, could somehow not have addressed ethics, morals, or the pursuit of a good life. We had our great insights. However, not only does the West remain unaware of Indian thought, but the average Indian also exhibits a significant ignorance of this rich heritage. This phenomenon exemplifies a colonial consciousness; that is, our lenses remain strictly Western to study ourselves.
This part of the essay draws upon the remarkable four-decade work of Dr. S. N. Balagangadhara, or Balu, as he is fondly called, a philosopher-academic at the University of Ghent, Belgium. He founded the Comparative Science of Cultures Program, which continues to yield significant insights. While we cannot explore his thesis in detail here, it is important to note that, when focusing solely on the ethical domain, Balu argues that Western morality may not be applicable to Eastern contexts and vice versa. Consequently, moral laws determined by one culture cannot be universally applied to all cultures across time. Thus, the fundamental assumption of Western normative ethics that ‘moral laws are universalisable’ may be wrong.
Cultural Differences In Morality: The Notions Of Agency and Action
The Western world has always dominated ethics as a domain of study, ignoring that other cultures may have their own perspectives too. Greco-Roman philosophers such as Socrates and Plato set the trajectory, with thoughts evolving in Europe according to historical developments. Thus, we have Christian theology, Protestant Reformation ideas, the Enlightenment, modernism, and postmodernism as the backgrounds that dominate thoughts and ideas. India is nowhere in the picture, as we only discuss philosophers like Descartes, Kant, Schopenhauer, Nietzsche, Hume, Locke, Voltaire, or Rousseau and talk about Continental or Analytical philosophy.
The fundamental categories that organize the moral domain of any culture stem from the culture itself. This is evident in the notions of agency in the West and Indian culture. Very briefly, the concept of an ‘agent’ in Western culture posits that within each individual lies an inner core (the actual self or the agent) that exists as separate and distinct from everything else. In contrast, Indian cultural philosophy emphasizes that the actions performed by an organism, as assessed by another being, define the agent. Thus, for example, in Indian culture, an agent can be a good father and a good son but be a bad husband at the same time. In Western culture, when performing an immoral act, an individual might say, “This is not me; I am something else.”
To get a better perspective of this part of the essay and to clarify the concepts, it is advisable to read the essay “Selfless Morality and the Moral Self” by Dr. S. N. Balagangadhara. The link has been provided in the references section. Before going further, it is useful to read what S. N. Balagangadhara writes to fully understand this:
The basic conception of self in the Western culture can be very briefly outlined thus: in each human being, there obtains an inner core which is separable and different from everything else. In such a culture, when one speaks of “finding oneself” one means that one should look inside oneself, get in touch with an inner self that is there inside oneself, and peel everything away that surrounds this core. To such a self, even its own actions can appear strange.
The Western culture allows each of us a self: a self waiting to be discovered within each one of us; something which can grow and actualize itself; that which either realizes its true potential or fails to do so etc. Such a self plays many roles: it guarantees identity when philosophers ask questions about self-identity; it acquires an identity when psychologists attempt to describe the processes and mechanisms by means of which a human organism builds an identity; it is the agent of the moral thinkers when they talk of moral agency etc. Such a versatile self has various properties. One of them is its reflexivity: the self is aware of itself as a self, or it has self-consciousness. … self-consciousness typifies the uniqueness of human beings, and that this distinguishes Man from the rest of Nature…Western notions of the ethical are simply incomprehensible in the absence of precisely such a concept of self.
…(In Indian culture) a distinction is not made between an agent who performs the action and the actions that the agent performs. An agent is constituted by the actions which an organism performs, or an agent is the actions performed and nothing more. And this appears to me to be the concept of ‘self’ that is present in Indian culture.
In order to better appreciate what is being said, let the letters ‘X’ and ‘Y’ stand for two biological organisms. In this case, the ‘self’ of X is nothing other than the actions that it performs. Even here, the nature and the character of the actions that X performs depends very much upon how Y construes them. There is another way of putting this: Y construes X’s ‘self’ in the same way X construes Y’s ‘self’. Y is very crucial for the construction of X’s ‘self’, because in the absence of Y the actions that X performs are meaningless. That is, Y is required so that X’s actions may be seen as some specific type of action or the other. If we were to restrict ourselves to X in order to talk about its ‘self’, so that we may contrast this notion with that of the West, we could say that its ‘self’ consists of a bundle of meaningless actions. Because of this, the ‘self’ of X crucially depends upon continuously being so recognized by Y.
There is nothing spooky or mysterious about this: you are a son, a father, a friend, etc. only to the extent you are so recognized. And you can only be thus recognized when you perform those actions which are appropriate to the “station” of a son, father, friend, etc. The presence of these gestalts in the culture of the community not only imposes restrictions upon the way Y can construct X’s ‘self’, and thus reducing the possible arbitrariness involved in such a construct, but it also enables X to challenge Y within limits.
In one culture, human organisms are endowed with selves in whose nature it is to be different from one another. A human organism builds an identity (in the psychological sense) for such a self; the latter, in its turn, is what makes such an endowed organism unique. This means that the self can be individuated, and the criteria for it are precisely its possessions: at the minimum, for example, the body of a human organism belongs to the self whose body it is. In the other culture, the ‘self’ is a meaningless bundle of actions created by human organisms. The psychological identity of such a ‘self’ is a construction of the ‘other’. A human organism which builds such a ‘self’ is conscious, to be sure, but it lacks that “self-consciousness” which is supposed to typify human beings. The dividing line between such a sentient or conscious ‘self’ and other sentient ‘selves’, where it is drawn at all, is of very little moral significance. That creatures other than human beings, under such a view, end up having ‘selves’ is not only not a problem, but also a recognized consequence.
Taking the example of an onion, in Western culture, peeling away the outer layers reveals the ‘true’ agent standing independently at the core. The entire task of a human being, or even psychoanalysis by various methods, is to discover this ‘true’ agent. However, in Indian culture, this peeling process leads to emptiness. As Balu says, these conceptions may not be explicitly framed in the writings, but understanding both Western and Indian ethics requires this conception of agency. These differing perspectives profoundly influence the moral frameworks in both Western and Indian cultures.
Again, very briefly, there are no elaborate theories on ethics or morals in Indian culture. Contextual appropriateness and not context-free rules, based on dharma, serve as the foundational basis for moral action, and stories play an enormous role in illustrating it. Thus, the same action can become moral or immoral, depending on its context. Indian culture possesses the world’s largest collection of stories, often considered more significant than established ethical conduct rules. It is as crucial a pedagogical tool to illustrate dharma and ethical behaviour as anything else for learning and teaching in Indian culture.
The metaphysical concepts of a culture significantly influence its ethical values. Indian culture is deeply rooted in beliefs such as the existence of reincarnation, the principle of karma, and the notion of a primary Consciousness (Brahman), with the attainment of mokṣa being the ultimate goal. In contrast, Western metaphysics focuses on a singular life devoid of karma, the idea of multiple selves, and a predominant emphasis on the material world, resulting in distinct ethical frameworks.
While Western philosophy seeks universal ethical laws, this perspective may not be applicable to Indian cultural contexts. It is not surprising that many Indians experience confusion, as we remain a vibrant and living culture, conscious of our roots while simultaneously absorbing Western values. In Western contexts, ethical theories concentrate on agents, actions, and their consequences, whereas Indian ethics place greater importance on the contextual appropriateness of actions and advocate for actions performed without desire.
Another distinction is that in Indian culture, humans, sentient beings, and non-sentient matter are regarded as equal, with no hierarchical relationships. ‘Harmony’ is the keyword for humans in relation to the rest of the non-human world. In contrast, Western culture, whether religious or secular, tends to prioritise humans over animals, plants, and inanimate objects. Nature, material and non-material, is at the service of humans placed at the apex of the pyramid. India exemplifies the clash between the values of living traditions and modernity, and nowhere is the confusion more evident than when we understand our ethical values using Western frameworks.
Western Ethics and Indian Ethics: Colonial Consciousness
Learning never finishes in any field, including morality, because the universe is complex. Western culture, obsessed with moral discussions, however, never questioned the idea that learning to be moral can have a terminus. This is the major problem in trying to search for universal moral laws applicable to all cultures across time.
In summary, the most fundamental category of “moral judgement” in Indian traditions is “appropriateness.” Actions lack meaning without contextual interpretations. As expressed in various Indian traditions, performing an act devoid of desire is regarded as the highest form of appropriate action. This perspective transcends the dichotomy of good and evil.
What makes one better than the other? Western culture dismisses the ideas of Indian culture when it comes to ethics or moral behaviour. Despite Western culture being obsessed with morality and ethical theories across centuries, it becomes the author of deeds that should genuinely chill anyone’s blood, as Balu suggests: the crusades, inquisitions, witch hunts, colonisation, world wars, nuclear bombs, the genocide of American Indians, Nazism, and the transformation of a continent and its cultures into slavery. Huge goodwill is required to believe that these cultures are not intrinsically evil. Indian culture also includes a history of torture, wars, and cruelties, but these are trivial in comparison, both in magnitude and scale, to the acts committed by the West. Consequently, when viewed through the lens of Western ‘ethics’, Indian traditions may seem morally reprehensible. Conversely, against the backdrop of Indian traditions, the West appears immoral.
Indian traditions such as Advaita, Buddhism, Jainism, Shaivism, and Vaishnavism have made important contributions to knowledge in many areas, including ethics and the arts. However, many Indians are unaware of these contributions and often accept foreign perspectives on India uncritically. While Western culture claims its views are the standard for humanity, this marginalises Indian ideas for specialised studies. The irony is that many Indian intellectuals and academics accept this idea.
Termination Of Pregnancy
Let us briefly look at the issue of abortion and the perspectives of each culture on this. The issue of abortion is a complex cocktail of politics, society, law, medicine, ethics, morals, religion, and human rights in the Western world. There are two entangled lives here, and a clash sets up between the autonomy of a mother who has a voice and a silent, dependent fetus. The crux of the issue is a contradiction between the two fundamental properties of a liberal life: the freedom to choose (for the mother) and the right to live (for the fetus).
There are numerous voices in this contentious debate. Political ideologies and religious ideas contribute their perspectives. Socio-cultural factors also play a significant role, particularly in Western countries. In the US, it is not unusual to find unwed mothers, but in India, conceptions occurring out of wedlock remain relatively uncommon, although their incidence may gradually rise in the future.
The Roe v. Wade case was notable in the US, establishing 24 weeks as the legal limit for termination. The ruling reflected a pragmatic perspective, devoid of any moral, ethical, or religious considerations. After 24 weeks, the fetus’s right to life was deemed paramount. Before 24 weeks, the mother’s autonomy to make choices was regarded as significant. However, advocating for either the freedom to choose or the right to life throughout all stages of pregnancy presents a potential conflict.
The so-called right wing adopts a pro-life stance, asserting a ‘no right to abort’ position. The so-called left wing, on the other hand, supports a pro-choice view and the right to have an abortion. Catholics maintain a stringent anti-abortion position, whereas Protestants exhibit a more varied attitude toward the issue, ranging from opposition to complete support. In a predominantly Catholic Ireland, an Indian dentist was refused an abortion in 2012 on religious grounds, and she died due to sepsis. The case led to a huge debate with later modifications to the law.
In an essay, “Abortion: Is It Possible To Be Both ‘Pro-Life’ And ‘Pro-Choice’?”, the famous scientist-author, Carl Sagan, asks, “When does ‘personhood’ emerge in a fetus?” Is it at conception, birth, or at some point in between? The criteria of the Supreme Court are on ‘survivability’ and lung maturity to take breaths outside the womb. Sagan agrees to 24 weeks, but on the basis of research that shows well-formed fetal brain waves, like a ‘proper person’. He asks pertinently, why should only breathing justify legal protection? If a fetus can think and feel but cannot breathe, would it be all right to abort it? Second, with better technology, a fetus might survive a much younger gestation. Technology shifts survivability criteria to lower ages. Sagan says, “A morality that depends on and changes with technology is a fragile morality; for some, it is also an unacceptable morality.”
Regarding the Indian scenario, the MTP Act of 1971 originally set a 20-week limit for pregnancy termination to safeguard maternal health. It was thought that terminations after 20 weeks of gestation were not safe for the mother. Recent amendments have extended this limit to 24 weeks for cases of severe fetal anomalies, reflecting advancements in medical procedures that have improved the safety of abortion even at later stages. This change offers a wider timeframe for addressing serious fetal issues, reducing the pressure on a previously limited window.
Nitin Sridhar’s detailed essay (Abortion: A Dharmic Perspective) illustrates that Indians and their dhārmika texts have also grappled with these issues. In ancient India, abortion was permitted up to 16 weeks based on various philosophical concepts. While the specifics are not detailed here, significant Indian metaphysical concepts such as the singular Self, individual jīva, karma, rebirth, dharma, adharma, and prāyaścitta are pertinent. Abortions done after 16 weeks were against the law, and those done before 16 weeks required a prāyaścitta. Abortion was Adharma, as it obstructed a jīva from experiencing physical birth, which is viewed as an entitlement derived from prārabdha karma.
The jīva associates with the fetus at conception but enters the hṛdaya around the fourth month of pregnancy. Therefore, an abortion after 16 weeks is regarded as equivalent to killing a person, leading to legal penalties. Before the 16th week, jīva is prevented from fully identifying with the fetus. Abortions performed before this period necessitate a 12-year prāyaścitta, which is a voluntary act of penance. Termination of pregnancy is only permissible without adharma if it is intended to save the mother’s life.
Concluding Remarks
The ethical, moral, legal, medical, and social aspects of fetal medicine are complex and will grow in the future. Some ethicists question whether a society can be considered healthy if it rejects any abnormality beyond its norms. They argue that the treatment of the disabled, the elderly, the sick, and even seemingly useless animals judges a society’s maturity. Indian culture, on the other hand, has a much higher acceptance of circumstances related to the concept of karma. Paraphrasing Sri Aurobindo in The Foundations of Indian Culture on karma:
Indian culture perceives a “Self” within us that transcends the ego and recognises all human possibilities…karma and reincarnation are misunderstood as a doctrinal negation of present life. In reality, both concepts significantly enhance the value of effort and action. The nature of our present actions shapes our immediate experiences and influences our future. Furthermore, the belief that our current sufferings stem from our past actions provides a sense of calm that the Western intellect often struggles to comprehend.
The question arises, “Why is my child abnormal, or why is there so much evil in the world?” Indian metaphysics perhaps has better answers with its consideration of multiple births and collective and individual karma. A single-life metaphysics of the West may struggle to find answers, viewing the beginning of life as a clean slate.
Today, Indians have a remarkable readiness to accept Western discourses for application to Indian culture. Our colonial consciousness prevents most Indian intellectuals from wearing Indian lenses to evaluate many of these tricky issues. Ethics is complex since we are primarily at the level of human reasoning.
Indian traditions and their ṛṣis have enunciated principles and ideas from supra-rational reasoning based on intuitions. They also showed us how to develop these higher states through yoga and meditation. However, very few people are willing to subject themselves to higher states of consciousness in order to understand what appropriate action means at a rational level. Finally, the question remains: can we evolve sustainable contemporary narratives and laws on fetal medicine, among other issues, based on the eternal principles enunciated in Indian traditions? Or have we travelled too far on a ship of modernity that looks at tradition only with disdain?
Selected References and Further Readings
- Gates EA: Ethical considerations in prenatal diagnosis, In Fetal Medicine [Special Issue]. West J Med (1993)
- Ethical considerations in prenatal genomic testing Ruth Horn, Alison Hall, Anneke Lucassen (Best Practice & Research Clinical Obstetrics & Gynaecology 97 (2024)
- Ethical challenges in fetal surgery Anna Smajdor (J Med Ethics 2011)
- Ethical issues in prenatal genetic diagnosis. Guidance for clinical practice. Report of the Joint Committee on Genomics in Medicine. London: RCP, RCPath and BSGM (2022)
- Legal and ethical issues in fetal surgery Bernard M. Dickens, Rebecca J. Cook International Journal of Gynecology and Obstetrics (2011)
- Ethical issues associated with prenatal screening using noninvasive prenatal testing for sex chromosome aneuploidy Molly Johnston et al (Prenatal Diagnosis. 2023).
- “Selfless Morality and the Moral Self” in Cultures Differ Differently: Selected Essays of S.N. Balagangadhara (2022) edited by Jakob De Roover, Sarika Rao. Also available at https://www.hipkapi.com/2011/03/05/comparative-anthropology-and-moral-domains-an-essay-on-selfless-morality-and-the-moral-self-s-n-balagangadhara/
- What does it mean to be ‘Indian’? by Sarika Rao S.N. Balagangadhara (2012)
- Abortion: Is It Possible To Be Both “Pro-Life” And “Pro-Choice”? by Carl Sagan and Ann Druyan (1990)
- Abortion, a Dharmic Perspective by Nithin Sridhar (2021)
- Renewing Eternity: Traditional Perspectives for the Modern Hindu by Margatham (2025)
- The Crisis of the Modern World by René Guénon (1923)
RANDOM MUSINGS 