Through advances in medical technology, the opportunities for intervening with patient destiny by restoring heart beat and respiration or kidney function, among other symptoms, are both numerous and fascinating. However, some people may believe that their destiny should not be tampered with (Tolumin, 1981). The question of whether to give or withhold care is a moral decision which health care professionals must deal with. Client choices may be justified by the principle of self-determination, and other decisions may be justified by the principle of the patient's best interests. Further complications arise when a pregnant but competent mother makes decisions regarding her fetus that will probably bring harm to it. Since a fetus cannot speak for itself, the question arises as to who will speak for it. Sound ethical decisions require listening to the mother and understanding the rights and meaning of personhood. Health care personnel must also analyze their attitudes, beliefs, and values after sticking to their professional policies and procedures and, finally, adhering to the law.
The case to be analyzed concerns preterm labor and prenatal harm. The subject is a 19-year-old unmarried woman, pregnant for the third time, having previously had an abortion at 15 and a daughter who is now 10 months old. The woman was admitted to the hospital in the 26th or 27th week of gestation and placed on intravenous medications, including magnesium sulfate, to stop her preterm labor. Two days later, the patient asked her physician to discontinue her medications because she was "tired of being in the hospital and the medications and the fetus were too uncomfortable." The doctor explained the potential risks of premature delivery (respiratory immaturity, intraventricular hemorrhage, neurological handicaps, and fetal death), which are very costly to handle--much more costly than if she would do what the physician advised, which was to contin...