Review Question - QID 221256

Despite her pregnancy, the patient has personal autonomy; therefore, she can decline cesarean section even at the risk of her child's life. Conversely, she cannot legally deny her child appropriate medical therapy once the child is born.

Physicians are legally and morally obligated to obtain informed consent for any treatments. This involves describing the purpose, risks, benefits, and alternatives for each proposed treatment. Pregnant women who have the capacity for consent may decline any treatment, regardless of the potential consequences for the fetus. Once the child is born, informed consent should be obtained from its parents prior to any treatment with the exception of emergency, life-threatening conditions in which delaying treatment would harm the patient. If the infant is at significant risk for death or severe neurological morbidity, then a relatively harmless intervention such as antibiotics should be provided regardless of the parents' wishes. Every effort should be made to counsel the mother and obtain informed consent prior to treatment of the infant.

Chervenak and McCullough review the evidence regarding the ethics that govern perinatal medicine. They discuss how justice and beneficence should be used in these cases. They recommend understanding how resource allocation can be divided to better serve patients.

Figure/Illustration A is a representation of a fetal heart rate tracing that demonstrates late decelerations that occur after the start of contractions (red lines). These findings are consistent with severe abnormalities that typically require emergent delivery.

Incorrect Answers:
Answer 1: Avoiding cesarean section and avoiding antibiotics after birth, even if the infant shows signs of infection, is a partially correct choice that respects the pregnant patient's autonomy. Despite the parents' wishes, physicians have a legal and moral obligation to treat children with time-sensitive, emergency, life-threatening conditions such as early GBS infection.

Answer 3: Consulting the hospital ethics committee is not necessary because the patient has autonomy legally and morally to refuse a cesarean section. The committee would likely take longer to process the decision than is available in this case of a patient in active labor.

Answers 4 & 5: Performing an emergent cesarean section is not appropriate because, despite her pregnancy, the patient has personal autonomy. Therefore, she can decline cesarean section even at the risk of her child's life.

Bullet Summary:
Pregnant patients may decline treatment, regardless of potential harm to the fetus; however, once the child is born, its parents cannot decline to treat the child for life-threatening conditions.