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Feticide – Definition, Procedure and Ethics

Feticide is a medical procedure that deliberately stops the heartbeat of a fetus in the womb, typically performed before a late-term termination or as selective fetal reduction in multiple pregnancies.

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Things worth knowing about "Feticide"

Feticide is a medical procedure that deliberately stops the heartbeat of a fetus in the womb, typically performed before a late-term termination or as selective fetal reduction in multiple pregnancies.

Definition

Feticide (also spelled foeticide) is a medical intervention in which the life of a fetus inside the uterus is intentionally ended. This is typically achieved by injecting a cardiac-arresting agent – most commonly potassium chloride (KCl) or digoxin – directly into the fetal heart or umbilical cord under continuous ultrasound guidance. The procedure is always performed by experienced medical specialists.

Indications

Feticide is carried out in specific clinical situations, including:

Late-term termination of pregnancy: From a certain gestational age (generally from 22 weeks of gestation onward), feticide is performed prior to induction of labor to ensure the fetus is not born alive. This protects all parties involved and ensures legal and medical clarity.
Selective fetal reduction in multiple pregnancies: In cases of higher-order multiple pregnancies (e.g., triplets or quadruplets), selective feticide may be performed to reduce health risks for the remaining fetuses and the pregnant person.
Severe fetal anomalies or conditions: When one fetus in a multiple pregnancy is diagnosed with severe, often life-incompatible abnormalities or genetic conditions, selective feticide may be considered to protect the health of the continuing pregnancy.

Medical Procedure

The procedure is performed under ultrasound guidance and is typically carried out on an outpatient or inpatient basis at a specialized center. The most commonly used agents are:

Potassium chloride (KCl): Injected intracardially (directly into the fetal heart), it causes cardiac arrest by disrupting the electrical activity of the heart.
Digoxin: Can be administered intraamniotic or intrafeally and likewise leads to fetal cardiac arrest.

After the procedure, ultrasound is used to confirm the absence of fetal cardiac activity. In cases of selective reduction, the remaining fetus or fetuses are monitored closely.

Legal and Ethical Considerations

Feticide is a medically and ethically complex topic. Legal frameworks vary considerably between countries. In many jurisdictions, feticide is only permitted under clearly defined medical indications and requires interdisciplinary counseling and the fully informed consent of the patient. Healthcare providers who object to performing the procedure on conscientious grounds are generally not legally obligated to do so.

Ethical discussions often center on questions of fetal pain, personhood, parental autonomy, and the responsibilities of medical professionals. Multidisciplinary teams including obstetricians, genetic counselors, ethicists, and psychosocial support professionals are typically involved in the decision-making process.

Psychosocial Support

For affected families, the decision to undergo feticide is associated with significant emotional distress. Comprehensive psychosocial counseling before and after the procedure is an essential component of care. Specialized counseling services and support groups can help individuals and families process the psychological impact of such a decision.

Risks and Complications

As with any invasive procedure during pregnancy, risks exist, including:

Infection
Preterm labor or preterm birth
Unintended injury to remaining fetuses in multiple pregnancies
Significant emotional and psychological burden for the person involved

The risk profile depends on gestational age, the number of fetuses, and the individual health circumstances of the patient.

References

Royal College of Obstetricians and Gynaecologists (RCOG) – Termination of Pregnancy for Fetal Abnormality. RCOG Green-top Guideline No. 63 (2010, updated 2023).
Evans MI, Andriole S, Britt DW. Fetal reduction: 25 years' experience. Fetal Diagn Ther. 2014;35(2):69-82. PubMed PMID: 24192432.
World Health Organization (WHO) – Safe Abortion: Technical and Policy Guidance for Health Systems. 2nd edition. Geneva: WHO; 2012.

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