ue the medications for two to three weeks to give the fetus time to mature. The doctor also told the patient that these few weeks would enhance the fetus' chance for survival (from 50 percent at 20 weeks gestation to 90 percent at 30 weeks gestation) and decrease morbidity, thus reducing the risk of chronic lung disease (from 50 percent at 26 weeks to 20 percent at 30 weeks gestation) and neurological handicaps later on in life (Marquis & Steinback, 1989).
The patient continued to refuse treatment, and a psychiatry consult was obtained. The patient was found to be extremely immature, emotionally labile and unrealistic and to be in a very poor social situation. She stated that she had been battered by several other family members, to have sometimes had suicidal feelings, to have used illegal drugs in the past, but not recently, and to have had a long-standing personality disorder (histrionic personality). Meanwhile, she continued to refuse the medication to stop labor, and she threatened to leave the hospital.
The physician has three options: respect the patient's wishes and risk delivering a very premature fetus who may expire or may survive in spite of prematurity and its complications; refuse to abide by her wishes and try to obtain a court order to force her to undergo treatment; or refuse to abide by her wishes but transfer her care to a physician who is willing to do so.
The values involved in this case on behalf of the patient are the right to autonomy and self-determination. The institutional values are the patient's right to refuse treatment. The physician's values also represent the patient's right to refuse treatment, along with autonomy and self-determination vs. the fetus' right to life as stated in the physician's oath: "The physician will have the utmost respect for human life from the time of conception . . . (Bandman & Bandman, 1985)." Therefore, the physician must be responsible for two lives, th...