Why do pregnant women refuse medical 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 …
Can a pregnant woman refuse a caregiver's recommendation?
Jun 14, 2016 · If you are pregnant, have been pregnant, or may become pregnant, and if your employer has 15 or more employees, you are protected against pregnancy-based discrimination and harassment at work under federal law. You may also have a legal right to work adjustments that will allow you to do your job without jeopardizing your health. This fact sheet briefly …
What to do if an obstetrician refuses to perform a procedure?
Jan 31, 1991 · To tolerate compelled invasive medical treatment of pregnant women would vest the fetus with rights superior not only to those of the woman whose medical choice is subordinated, but also to those of existing children who have no right to compel parents to undergo surgery or to donate organs for their benefit 19 This ruling is consistent with other trial …
What are some examples of medical malpractice in pregnancy?
Jan 01, 1998 · Legally, the health care provider owes the pregnant substance-using woman, her fetus, and the state two duties: to maintain confidentiality of the information disclosed and to respect patient autonomy by soliciting patient informed consent for treatment and honoring refusal of treatment. This includes toxicology screenings for controlled substances.
Can a pregnant woman refuse medical treatment?
Pregnancy is not an exception to the principle that a decisionally capable patient has the right to refuse treatment, even treatment needed to maintain life. Therefore, a decisionally capable pregnant woman's decision to refuse recommended medical or surgical interventions should be respected.
What are some consequences of not having adequate medical care during pregnancy?
Failure to perform prenatal care has been associated with adverse outcomes during pregnancy and childbirth. Moreover, complications such as congenital syphilis, neonatal death, and preterm birth are strongly correlated with a lack of prenatal care.
What can you refuse during pregnancy?
What to Reject When You're ExpectingElective early delivery. ... Inducing labor without a medical reason. ... C-section with a low-risk first birth. ... Automatic second C-section. ... Ultrasounds after 24 weeks. ... Continuous electronic fetal monitoring. ... Early epidurals. ... Routinely rupturing amniotic membranes.More items...•Jul 24, 2015
What happens if a patient refuses ac section?
If the woman continues to refuse a Cesarean section, and the team doesn't take some action, such as forcibly performing the procedure in the next few hours, it is very likely that both will die. The woman appears to have decision-making capacity.Sep 1, 2017
Can I get in trouble for not getting prenatal care?
Is it illegal to not get prenatal care? There are no laws in the United States requiring expectant mothers to obtain prenatal care. Receiving medical care can be a highly personal decision, and the U.S. government treads lightly in forcing individuals to receive or not to receive certain care during their lives.
Which of the following is considered a high risk condition for pregnancy?
High blood pressure, obesity, diabetes, epilepsy, thyroid disease, heart or blood disorders, poorly controlled asthma, and infections can increase pregnancy risks.
Can you decline fetal monitoring?
As a result, most hospitals suggest intermittent fetal monitoring. Although you can refuse monitoring entirely, the staff may be unhappy about this and ask you to sign a form or statement releasing them from liability if anything goes wrong during the labor and birth.
Can you refuse STD testing during pregnancy?
If you have had all of the STD tests done during the early pregnancy and have NO new risk factors, it is ok to decline the tests that are offered later in pregnancy.Jan 31, 2019
Can a woman refuse a C section?
A woman has a right to refuse surgical delivery without regard for the risk to the fetus. She may refuse a cesarean section for reasons that have no medical basis, even if her decision endangers the life or health of her fetus.
Can you force a woman to have ac section?
A doctor or hospital can't force a c-section without a court order. “A doctor cannot compel a woman to undergo a medical procedure without a court order,” said civil rights lawyer Jeff Filipovits. Sometimes doctors tell women that a c-section is “hospital policy,” and that the woman must therefore have the surgery.Nov 30, 2018
Are C sections ethical?
Although cesarean section in without clinical indication is considered ethically justifiable by the American College of Obstetricians and Gynecologists, and Italian law permits it, the advice by the UK National Institute of Clinical Excellence (NICE) is that such a request by a woman necessitates seeking a second ...
Are C sections required?
A C-section might be needed if you're carrying twins and the leading baby is in an abnormal position or if you have triplets or more babies. There's a problem with your placenta. If the placenta covers the opening of your cervix (placenta previa), a C-section is recommended for delivery. Prolapsed umbilical cord.Jun 12, 2020
What are the challenges of risk assessment during pregnancy?
Risk assessment during pregnancy poses unique challenges to patients and physicians. Interventions recommended during pregnancy and childbirth may reflect distortions of risk based on concerns about failure to intervene rather than robust considerations of risks associated with those interventions 34. Risk assessment in the context of a pregnant woman’s refusal of recommended treatment should address concerns regarding the respective benefits of the procedure to the pregnant woman and the fetus, the probability of harm to the pregnant woman and the fetus from either performing or withholding the procedure, and the risks and benefits of less intrusive treatments, when available.
Is pregnancy an exception to the principle that a decisionally capable patient has the right to refuse treatment?
Pregnancy is not an exception to the principle that a decisionally capable patient has the right to refuse treatment, even treatment needed to maintain life. Therefore, a decisionally capable pregnant woman’s decision to refuse recommended medical or surgical interventions should be respected.
What is the most challenging scenario in obstetrics?
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 . Such cases call for an interdisciplinary approach, strong efforts at effective medical communication, and resources for the patient and the health care team. The most suitable ethical framework for addressing a pregnant woman’s refusal of recommended care is one that recognizes the interconnectedness of the pregnant woman and her fetus but maintains as a central component respect for the pregnant woman’s autonomous decision making. This approach does not restrict the obstetrician–gynecologist from providing medical advice based on fetal well-being, but it preserves the woman’s autonomy and decision-making capacity surrounding her pregnancy. Pregnancy does not lessen or limit the requirement to obtain informed consent or to honor a pregnant woman’s refusal of recommended treatment.
Why are coercive policies counterproductive?
Coercive and punitive policies are potentially counterproductive because they are likely to discourage prenatal care and successful treatment while undermining the patient–physician relationship. Attempts to criminalize pregnant women’s behavior may discourage women from seeking prenatal care 23. Likewise, court-ordered interventions and other coercive measures may result in fear on the patient’s part about whether her wishes in the delivery room will be respected, which could discourage the pregnant patient from seeking care. Therefore, when obstetrician–gynecologists participate in forced treatment of their pregnant patients, outcomes for the patients and the fetuses may worsen rather than improve.
What is the ethical obligation of an obstetrician?
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. The obstetrician–gynecologist’s professional obligation to respect a pregnant patient’s refusal of treatment may conflict with his or her personal values.
How to communicate with a pregnant patient who refuses medically recommended treatment?
Although there is no universal approach to communicating with and caring for a pregnant patient who refuses medically recommended treatment, steps can be taken to mediate conflict, diffuse intense emotions, and encourage consideration of the patient’s perspective. These steps may create space, even under time constraints, to ensure that patients are fully heard and considered.
What happens if a pregnant woman refuses to follow medical advice?
When a pregnant woman refuses recommended medical treatments or chooses not to follow medical recommendations, there can be a range of minor to major risks to the patient or the fetus. In certain situations, a pregnant woman might refuse therapies that the medical professional believes are necessary for her health or survival, that of her fetus, or both. Examples of these situations include a pregnant woman refusing to treat a fetal condition or infection in utero or to undergo cesarean delivery when it is thought to be medically necessary to avoid an adverse fetal or maternal outcome.
What are the rights of pregnant women?
If you are pregnant, have been pregnant, or may become pregnant, and if your employer has 15 or more employees, you are protected against pregnancy-based discrimination and harassment at work under federal law. You may also have a legal right to work adjustments that will allow you ...
What does it mean when symptoms come and go?
If your symptoms come and go, what matters is how limiting they would be when present.
How long does it take to file a discrimination claim?
Because you must file a charge within 180 days of the alleged violation in order to take further legal action (or 300 days if the employer is also covered by a state or local employment discrimination law), it is best to begin the process early.
Is it illegal to retaliate against an employer?
It is illegal for your employer to retaliate against you for contacting the EEOC or filing a charge. For more information, visit https://www.eeoc.gov, call 800-669-4000 (voice) or 800-669-6820 (TTY), or visit your local EEOC office ( see https://www.eeoc.gov/field/index.cfm for contact information).
Is it illegal to smoke while pregnant?
While tobacco abuse or excessive weight gain during pregnancy do have detrimental effects on the unborn child and are not ideal, they are not illegal; cocaine abuse and murder are. Such speculation does not offer a viable prudence-based objection.
Why was Melissa Rowland arrested?
Melissa Rowland, a 28 year old woman who had been pregnant with twins, was charged by the State of Utah in 2004 with murder and child endangerment for refusing to permit a timely cesarean section that resulted in the death of one of her twins. The story is complicated by the fact that Melissa had four other children (two of which were previously delivered by cesarean section): two were given up for adoption, and one was taken away by child protective services. She carried a diagnosis of oppositional defiant disorder and had been convicted of felony larceny, as well as endangerment of another child in the past. She apparently had traveled from Florida to Utah in order to give these twins up for adoption, and had sought no prenatal care.
When was the ACOG opinion published?
Their position was reiterated by the American College of Obstetricians and Gynecologists (ACOG) in a Committee Opinion published in November 2005 entitled, “Maternal Decision Making, Ethics, and the Law.”.
What are the policies of GWUMC?
Forced by the Angela Carder case to study law and ethics involved in compelled treatment, GWUMC adopted policies which implement the doctrine of informed consent for pregnant women as well as all other patients. While the adoption of such policies resulted in the settlement of civil litigation against the hospital, the policies were independently crafted and approved by its Ethics Committee, appropriate medical staff and advisors. These policies embrace the guidelines and recommendations of the AMA and ACOG, promote the quality of the decision-making process, and anchor the responsibility for treatment decisions within the doctor-patient relationship.
Is judicial intervention inappropriate?
Similarly, after a comprehensive and thoughtful study, the Board of Trustees of the American Medical Association (AMA) recently concluded that judicial Intervention "is inappropriate when a woman has made an informed refusal of treatment designed to benefit her fetus.".
What is substance use in nursing?
Substance use occurs among women of all demographic groups. Current legal issues provide the foundation for an ethical analysis of the goals, values, and professional obligations of nurses caring for substance-using women.
Is the fair allocation of resources for individual and community needs ethical?
The fair allocation of resources for individual and community needs is an ethical issue. Not only are health care resources not available and allocated to all, but we have to ask, have social resources such as jobs, education, and housing been fairly and equally allocated for all people. Drug use does occur in all contexts, but social context resources often determine if punishment (prison) or treatment are chosen. For example, the Betty Ford clinic and other inpatient treatment centers are not filled with low-income patients, and conversely, people in prison for drug use tend to be poor.
What is the broadest legal issue?
The broadest legal issue is a national dilemma: the conceptualization of addiction as a legal or health care problem. This issue has been repeatedly recognized by the U.S. Supreme Court (
What is acute ethics?
“Acute ethics” is the mode used in most ethical conflicts. Acute ethics is “reacting to preventable conflict after it occurs, often in situations in which there is inadequate time for thoughtful and mutually respectful discussion” (
What are the guidelines and strategies used in the care of substance-using women?
The guidelines and strategies used in the care of substance-using women are formed by three concepts: attitudes, information, and skills. For providers, the focus usually is on changing behavior with information. Providers go to workshops about substance-using women, buy books, and watch videotapes. This information phase is necessary but not sufficient. To be effec-
What is the provider-patient relationship?
The provider-patient relationship is the cornerstone to effective treatment for women (
What is the ethical principle of autonomy?
The ethical principle of autonomy gives women a fundamental right to security of person. The principles of beneficence and nonmaleficence are caregivers' duties to “do what is best,” and “do no harm.”. Usually, women and caregivers agree on the best course of action and informed consent is straightforward. Occasionally however, a woman declines ...
Can you have a vaginal birth after a cesarean?
Most clinicians would recommend a vaginal birth after cesarean (VBAC) for a woman who has already had a successful vaginal birth; however, if she was at 41 weeks with an unripe cervix, many would recommend repeat cesarean rather than induction of labor.
What is the Universal Declaration of Human Rights?
1 This includes the right to decline any medical procedure that violates her bodily integrity, even if that refusal increases her or her fetus' risk of death .
What happens if a pregnant woman refuses a caregiver's recommendation?
By refusing a caregiver's recommendation, a pregnant woman's choice may put her and the fetus at increased risk of harm. In continuing to care for her, it must be clear to everyone that her clinician is respecting her right to choose and not endorsing her choice. If the stakes are high, it is advisable to ask a second consultant to counsel the patient to ensure she is truly informed. Patients, families, caregivers, risk managers, indemnity providers, lawyers, and judges all need to be aware that a patient is ethically and legally responsible for any adverse outcome that results from their refusal.