Objectives

1. Identify and explain the major ethical considerations speciic to reproductivedecision-making, including the moral status of the fetus, the status of the pregnantwoman, and the maternal–fetal relationship.

2. Describe ethical challenges associated with contraception and pregnancytermination, including the legal and cultural context surrounding conscientiousrefusal.

3. Describe the ethical challenges associated with conception and loss, includingmanagement decisions in the context of significant fetal anomalies.

4. Describe the ethical challenges involved in the management of pregnancy,including potential conlicts between maternal health needs or behaviors and fetalwell-being, and decisions about mode of delivery.

Case 1

T.D. is a 22-year-old woman who presented to the emergency room after being raped by a coworker.She underwent a full rape work-up; although standard procedure is to offer her emergencycontraception, the emergency room physician felt that doing so would be a conflict ofconscience for him, so he refused to write the order. The nursing staff raised concerns that thephysician was putting his own interests before those of his patient and failing to provide standardcare. The physician countered that it is his right – even his obligation – to act in accordancewith his conscience.

Case 2

L.G. is a 28-year-old with a history of multiple miscarriages. In her last pregnancy, a cerclage (astitch around the cervix) was placed; she carried the pregnancy to term and delivered a healthychild. Now pregnant at 14 weeks, she had planned cerclage placement again; however, an ultrasoundrevealed an anencephalic fetus. The patient declined abortion and requested the cerclagebe placed, but her doctor refused, arguing the risks of cerclage placement (anesthesia,infection) were not justified absent the possibility of meaningful life for her child.