The patient presented at night. She was at forty-two weeks gestation, in stalled labor, with fetal heart rates in prolonged deceleration. Due to the hour, no records were available from the outside facility where she said she had received prenatal care. An urgent cesarean section was recommended, but she refused. Her husband was passively supportive of her decision. There were some concerns about mental illness, but no clear history was known to the team. Over the next several hours, the obstetric team attempted to respectfully persuade her to accept the cesarean as the fetus was in very serious distress. An ethics consult was requested. The patient acknowledged that her baby could die or suffer grave damage but felt doctors are too eager to deliver by c-section and that the baby would be fine. She also said she would be so traumatized by a cesarean that she did not think she could bear it.

The team considered whether the patient had decision-making capacity and what could be done to assist the fetus without harming the mother. The ethicist questions whether she could have done more to balance the competing vulnerabilities in this case.