When pregnant patients refuse interventions.

Good communication between clinician and pregnant patients should avert most decision-making conflicts. Pregnant women may legitimately refuse prenatal screening procedures in view of the limited follow-up options. They also may choose alternatives to most standard obstetric interventions; clinical studies raise questions about the necessity of these interventions. A well-informed woman may refuse cesarean delivery in most situations: predictions of harm are highly uncertain, and she would be asked to accept risk and harm for the sake of another. However, in exceptional situations in which harm to the fetus is nearly certain and vaginal delivery also endangers the woman, the harm-to-others principle limits autonomy, and coercion may be ethically justifiable.