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14 - Ethical dilemmas in the care of pregnant women: rethinking “maternal–fetal conflicts”

Published online by Cambridge University Press:  30 October 2009

By
Françoise Baylis ,
Sanda Rodgers  and
David Young
Edited by
Peter A. Singer  and
A. M. Viens
Françoise Baylis
Affiliation:
Faculty of Medicine Dalhousie University, Canada
Sanda Rodgers
Affiliation:
Faculty of Law University of Ottawa, Canada
David Young
Affiliation:
Faculty of Medicine Dalhousie University, Canada
Peter A. Singer
Affiliation:
University of Toronto
A. M. Viens
Affiliation:
University of Oxford
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Summary

Ms. A is 19 years old and 25 weeks pregnant. Although her pregnancy was unplanned, at no time has she considered pregnancy termination. During a prenatal office visit, Ms. A reveals that she has a daily drug habit that includes crack cocaine and intravenous narcotics. She refuses to consider a change in her behavior, despite a thorough review of the potential effects of her substance abuse on her pregnancy outcome. Specifically, she refuses to participate in a methadone or other substance-abuse program.

Ms. B is 24 years old and has been in labor for 18 hours. The cervical dilatation has not progressed past 3 cm. The fetal heart rate tracing has been worrisome but is now seriously abnormal, showing a profound bradycardia of 65 beats per minute. This bradycardia does not resolve with conservative measures. Repeat pelvic examination reveals no prolapsed cord and confirms a vertex presentation at 3 cm dilatation. The obstetrician explains to Ms. B that a cesarean section will be necessary because of suspected fetal distress. Ms. B absolutely refuses, saying “No surgery.”

What are ethical dilemmas in the care of pregnant women?

When a pregnant woman engages in behavior(s) that may be harmful to her fetus, or refuses a recommended diagnostic or therapeutic intervention aimed at enhancing fetal health and well-being, her physician may experience an ethical dilemma.

Type
Chapter
Information
The Cambridge Textbook of Bioethics , pp. 97 - 103
Publisher: Cambridge University Press
Print publication year: 2008

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