The American College of Obstetricians and Gynecologists’ (ACOG) Committee on Ethics released a “Committee Opinion” [in June 2016] that outlines what doctors should do when a woman refuses the treatment recommended to her by an obstetrician.
A desire to protect the health and safety of the unborn baby may be at odds with the ethical obligation to safeguard a woman’s autonomy and right to choose what happens to her own body. In these cases, the Committee says, doctors are obliged to respect the patients decisions without attempt at coercion.
Refusal of Medically Recommended Treatment During Pregnancy
ABSTRACT: One of the most challenging scenarios in obstetric care occurs when a pregnant patient refuses recommended medical treatment that aims to support her well-being, her fetus’s well-being, or both. In such circumstances, the obstetrician–gynecologist’s ethical obligation to safeguard the pregnant woman’s autonomy may conflict with the ethical desire to optimize the health of the fetus. Forced compliance—the alternative to respecting a patient’s refusal of treatment—raises profoundly important issues about patient rights, respect for autonomy, violations of bodily integrity, power differentials, and gender equality. The purpose of this document is to provide obstetrician–gynecologists with an ethical approach to addressing a pregnant woman’s decision to refuse recommended medical treatment that recognizes the centrality of the pregnant woman’s decisional authority and the interconnection between the pregnant woman and the fetus.
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