Ethical Issues in the Neurology of Pregnancy

Abstract

Decision making for pregnant women and fetuses who suffer brain injuries is emotionally difficult and conceptually challenging. Occasionally, both the pregnant woman and the fetus have suffered an injury that confers a poor neurological prognosis, and decisions about one of them will have implications for the other—making the process of decision making even more problematic. In this article, decision-making standards and principles are reviewed for both pregnant women and fetuses, using a real case from the author's institution. Practical suggestions are made regarding deliberative processes and consultative models that can help with these difficult cases.

KeyWords

medicalcare - ethics - end-of-life decision - decision making - advance directive - health care proxy - pregnancy - brain injury

• References

• 1 Beauchamp TL, Childress JF. A framework of standards for surrogate decision making. In: Pierce J, Randels G. , eds. Contemporary Bioethics. Oxford: Oxford University Press; 2012
• 2 Beauchamp TL, Childress JF. Principles of Biomedical Ethics, 7th ed. Oxford: Oxford University Press; 2012
• 3 Ringer SP. Neonatal intensive care unit (NICU) ethics. In Toy EC, Raine SP, Cochrane TI. , eds. Case Files: Medical Ethics and Professionalism. New York: McGraw Hill; 2015: 267-277
• 4 Hagen EM, Therkelsen OB, Førde R, Aasland O, Janvier A, Hansen TW. Challenges in reconciling best interest and parental exercise of autonomy in pediatric life-or-death situations. J Pediatr 2012; 161 (01) 146-151
• 5 Harrison H. The offer they can't refuse: parents and perinatal treatment decisions. Semin Fetal Neonatal Med 2008; 13 (05) 329-334
• 6 McHaffie HE, Laing IA, Parker M, McMillan J. Deciding for imperilled newborns: medical authority or parental autonomy?. J Med Ethics 2001; 27 (02) 104-109