Maternal-Fetal Conflict: Case 1
A 29-year-old woman had an obstetrical ultrasound at 33 weeks to follow-up a previous finding of a low-lying placenta. Although the placental location was now acceptable, the amniotic fluid index (AFI) was noted to be 8.9 cm. Subsequent monitoring remained reassuring until 38.5 weeks, when the AFI was 6 cm. The patient declined the recommendation to induce labor, and also refused to present for any further monitoring. She stated that she did not believe in medical interventions. Nevertheless, she continued with her prenatal visits. At 41 weeks, she submitted to a further AFI, which was found to be 1.8 cm. She and her husband continued to decline the recommendation for induced labor.
Which ethical duty takes precedence, the duty to respect the patient's autonomous decision, or the duty to benefit a viable fetus? Is induction of labor a harmful intervention, subject to the principle of nonmaleficence?
Induction of labor at term is an intervention with demonstrated efficacy and carries low risk to the mother. In this case, it could prevent serious damage to a viable fetus. Informed discussion and persuasive efforts should be continued towards this goal. However, deliberate disregard of maternal refusal for therapy could constitute assault. So long as the fetus is attached to the pregnant woman, her body maintains its life, and bars access to it.