Coverdale J H, Chervenak F A, McCullough L B, Bayer T
Department of Psychiatry and Behavioural Science, University of Auckland, New Zealand.
Am J Obstet Gynecol. 1996 Jan;174(1 Pt 1):169-73. doi: 10.1016/s0002-9378(96)70390-3.
This article proposes ethically justified clinical guidelines for managing depressed patients during pregnancy.
We reviewed literature on depression and its consequences for pregnancy and related that literature to ethical principles.
The health effects of depression on the pregnant woman and her fetus cannot be managed without consideration of the chronic and variable impairment of autonomy that may result from the effects of depression on the pregnant woman's decision-making capacity.
When the fetus is previable, recommendations concerning the disposition and prenatal diagnosis of the pregnancy should be nondirective, whereas strong treatment recommendations are justifiable if the pregnant woman has decided to continue her pregnancy and is severely depressed. After viability, directive counseling for fetal benefit is ethically justified. The guidelines focus on preventive ethics strategies to enhance the decision-making capacity of the depressed pregnant patient.
本文提出了在孕期管理抑郁症患者的符合伦理的临床指南。
我们回顾了关于抑郁症及其对妊娠影响的文献，并将该文献与伦理原则相关联进行研究。
若不考虑抑郁症对孕妇决策能力的影响可能导致的长期和可变的自主性损害，就无法处理抑郁症对孕妇及其胎儿的健康影响。
当胎儿尚未具备存活能力时，关于妊娠处置和产前诊断的建议应是非指导性的；而如果孕妇决定继续妊娠且患有严重抑郁症，则提出强有力的治疗建议是合理正当的。在胎儿具备存活能力后，出于胎儿利益进行指导性咨询在伦理上是合理的。这些指南侧重于预防性伦理策略，以提高患有抑郁症的孕妇的决策能力。
