msyamp
Forum Fanatic
Topics: 60
Posts: 1,462
|
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?
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?
___________________
If you think you can You can! If you think you cant you are right again!!
|
| drk1980
Forum Guru
Topics: 147
Posts: 1,038
|
wow, tough ones! u sure these aren't step2!? 
first case all i can say is mom is competent and maternal autonomy prevails over ethical concerns.
|
| sturge_weber
Forum Guru
Topics: 77
Posts: 1,042
|
the physician can ensure non maleficience for the mother, by not considering what she says, as the main purose of non maleficience is that the doctor wants to prevent the harm by not taking a decision
and beneficience is that taking terbutaline is going to be beneficial to the fetus, i dont think the doc should go for maternal autonomy
|
| sturge_weber
Forum Guru
Topics: 77
Posts: 1,042
|
in the second case, i would go for duty to benefit a viable fetus
|
| Geroo
Forum Guru
Topics: 114
Posts: 799
|
I think the mother has the right to decide,and for both cases the doc should go with maternal autonomy.but the doc can't not decide competence,it's the court job.
|
| drk1980
Forum Guru
Topics: 147
Posts: 1,038
|
i was under the impression that the doctors cant decide INcompetence, instead deciding on that is teh courts job. Otherwise all patients to be taken as competent.
|
| sturge_weber
Forum Guru
Topics: 77
Posts: 1,042
|
well ya doctors cant decide competence, its the courts job, u re right....
|
| satyaking
Forum Junior
Topics: 5
Posts: 58
|
In the first case we have to talk with the patient and adress her about the benefits of terbutaline.even then if she goes by her decision then psychiatric evaluation is done.If she is incompetent then court has to decide about it or if competent then maternal autonomy prevails.
Well comming to the second case we have to adress the patient about the benefits of induction of labour that is benefits over risks and If she is competent and does not agree with the doctors suggestion the maternal autonomy prevails in this case
|
| dariush
Forum Elite
Topics: 20
Posts: 356
|
1st case :i agree. Competence should be judged by court BUT physician could potentially get court order for "Incompetence" if he determines her behavior is as a result of a e.g. Schizophrenic state (e.g. Hallucinations) but she does not mention any Hallucinations and this is simply a "Dellusion" at worst.
2nd case: Pregnant mother has every right to decline any intervention even if it results in harm or death of the baby. a COMPLETE Autonomy of a normal competent human.
___________________
Allah (God) is watching over us...
|
|
| |
| | | | | | | | | |
