Earlier this month, The American College of Obstetricians and Gynecologists’ (ACOG) Committee on Ethics issued an opinion paper on “Refusal of Medically Recommended Treatment During Pregnancy.” The document laid out a series of nine recommendations for what doctors should do when pregnant women refuse medical treatments indicated by their obstetrician–gynecologists (OB/GYN).1
The document underscores the ethical importance of respecting the right of patients to refuse treatment, and it specifically points out that forcing pregnant women to comply with treatment “raises profoundly important issues about patient rights, respect for autonomy, violations of bodily integrity, power differentials, and gender equality.”1 It adds, “Coercive interventions often are discriminatory and act as barriers to needed care.”1
According to the Committee on Ethics, the purpose of its opinion paper is to:
provide obstetrician–gynecologists with an ethical approach to addressing a pregnant woman’s decision to refuse recommended medical treatment that recognizes the centrality of the pregnant woman’s decisional authority and the interconnection between the pregnant woman and the fetus.1
The Committee on Ethics says that the actions of obstetrician-gynecologists, when providing care to pregnant women, should be guided by the informed consent ethical principle and that “adult patients who are capable decision makers have the right to refuse recommended medical treatment.”1 It acknowledges that this “doctrine” has “evolved through legal cases, regulations, and statutes that have established the requirement of informed consent to medical treatment in order to effect patient self-determination and preclude violations of bodily integrity.”
The Committee on Ethics also recognizes that “informed refusal” is the “corollary” of informed consent. It states:
[I]t is an ongoing process of mutual communication between the patient and the physician and enables a patient to make an informed and voluntary decision about accepting or declining medical care. The informed consent process ideally begins before decision making so that the patient is able to make an informed choice (ie, informed consent or informed refusal) based on clinical information, the patient’s values, and other considerations of importance to her.
An article in Mothering magazine reviewing the ACOG Committee on Ethics’ opinion paper hones in on the issue of voluntary informed consent, noting that, “by nature” then, informed refusal must also be an option and, in fact, is “just as valid a choice.”2
1 The American College of Obstetricians and Gynecologists. Refusal of Medically Recommended Treatment During Pregnancy. ACOG.org No. 664, June 2016.
2 McClain L. New ACOG Statement Says Forcing Treatment on Pregnant Women is Unethical. Mothering June 10, 2016.