Maternal-Fetal Conflict: Case 2
A 22-year-old woman in her first pregnancy with an unremarkable prenatal course presents with preterm labor at 28 weeks gestation. Her contractions were successfully stopped with terbutaline. Discharge planning was reviewed with her, and she was instructed to follow a regimen of bedrest and oral terbutaline. She reported that she did not intend to comply with these instructions. She believed that God would not allow her to labor unless it was time for the baby to deliver, and she indicated that He had communicated this to her.
How can the physician ensure nonmaleficence towards the mother and still promote beneficence towards her fetus? Is the mother competent? Should maternal autonomy prevail over other ethical concerns?
The gestational age of this pregnancy places the fetus on the border of viability. Extensive, non-coercive discussions are essential to ensure that this patient understands the implications of refusing therapy. You may suggest that she invite her spiritual advisor to meet with both of you to talk together about her beliefs and the impact on her fetus.
If her refusal persists, in light of her unconventional religious claims, a psychiatric consultation might be requested to evaluate her competency. If competency is documented, the ethical principle of nonmaleficence would support refraining from performing any unwanted interventions. If the patient is found to be incompetent, judicial intervention could be considered.