Refusing to Force Treatment

Abortion is illegal after viability in most US states. However, the law permits, and ethics require, clinicians to respect pregnant people’s refusal of medical treatment throughout pregnancy and delivery even when it might prevent fetal demise or harm. This chapter explains why these seemingly contradictory standards are in fact consistent. It contextualizes pregnant people’s right to refuse medical intervention within the history of the legal and moral status of women, viable fetuses, and women pregnant with viable fetuses, and argues that the principle of justice breaks the tie that some people perceive between autonomy (of women) and beneficence (to fetuses), pushing the scales in favor of women. Finally, it offers ethically sound steps that obstetricians confronted with refusals should take to maximize care, and it considers the moral distress these unusual cases invariably invoke.