Terminating a pregnancy in Intensive Care Unit without the patient's consent: Ethical and medico-legal issues.

Authors

  • Grégoire Moutel 1. Espace Régional de Réflexion Ethique, CHU de Caen, Normandie Université, Unicaen 14000 Caen, France. 2. Service de médecine légale et droit de la santé, CHU de Caen, Normandie Université, Unicaen 14000 Caen, France. 3. Inserm U1086, ANTICIPE, Normandie université, Unicaen, 14000 Caen, France
  • Pauline Goupille Service de Gynécologie-Obstétrique et Médecine de la Reproduction, CHU de Caen, Normandie Université, Unicaen 14000 Caen, France
  • Bertille Suzat 1. Espace Régional de Réflexion Ethique, CHU de Caen, Normandie Université, Unicaen 14000 Caen, France. 2. Service de médecine légale et droit de la santé, CHU de Caen, Normandie Université, Unicaen 14000 Caen, France
  • Jean-Philippe Rigaud 1. Espace Régional de Réflexion Ethique, CHU de Caen, Normandie Université, Unicaen 14000 Caen, France. 2. Département de réanimation, Centre Hospitalier Général de Dieppe, 76202 Dieppe, France.
  • Maud Charvin 1. Espace Régional de Réflexion Ethique, CHU de Caen, Normandie Université, Unicaen 14000 Caen, France. 2. Inserm U1086, ANTICIPE, Normandie université, Unicaen, 14000 Caen, France
  • Guillaume Grandazzi 1. Espace Régional de Réflexion Ethique, CHU de Caen, Normandie Université, Unicaen 14000 Caen, France. 2. Centre de recherche risques et vulnérabilités EA3918, Normandie université, Unicaen, 14000 Caen, France
  • Mylène Gouriot 1. Espace Régional de Réflexion Ethique, CHU de Caen, Normandie Université, Unicaen 14000 Caen, France. 2. Inserm U1086, ANTICIPE, Normandie université, Unicaen, 14000 Caen, France.
  • Clément Gakuba Service d’Anesthésie Réanimation, CHU de Caen, Normandie Université, Unicaen, Normandie, 14000 Caen, France.
  • Thomas Gaberel Service de Neurochirurgie, CHU de Caen, Normandie Université, Unicaen, Normandie, 14000 Caen, France.
  • Guillaume Benoist 1. Espace Régional de Réflexion Ethique, CHU de Caen, Normandie Université, Unicaen 14000 Caen, France. 2. Service de Gynécologie-Obstétrique et Médecine de la Reproduction, CHU de Caen, Normandie Université, Unicaen 14000 Caen, France

DOI:

https://doi.org/10.37051/mir-00095

Keywords:

Autonomy, Consent, Incapacity, Termination of pregnancy, Collegiality, Decision making, Resuscitation, Trusted person, Family, Medical secrecy and information

Abstract

In France, the voluntary interruption of a pregnancy for medical reasons can be requested by the woman, whatever the term of the pregnancy, if it is attested that the continuation of the pregnancy seriously endangers her health. The termination of the pregnancy is then subject to the collegial opinion of a Pluridisciplinary Centre for Prenatal Diagnosis, which must give a favourable decision after analysing the situation. Following, it is the woman who takes the final decision. Respect for the autonomy of the pregnant woman is therefore a fundamental principle in prenatal diagnosis and termination of pregnancy in French law.

In this article, we analyse a situation that raises complex ethical and decision-making issues where the termination of pregnancy is required when the patient is neither able to formulate a request nor to consent, due to her pathology requiring hospitalization in intensive care.

If the continuation of the pregnancy poses a serious threat to the patient's health, urgency may be an acceptable argument for acting without the patient's consent. This urgency is understood here as the fact that, without a rapid decision, the clinical situation has little chance of improving or even deteriorating. In this context, we discuss the arguments for terminating the pregnancy and the importance of consulting the parents and spouse, so as not to exclude relatives from the decision-making process. Finally, our analysis questions the limits of medical secrecy in intensive care when a dialogue and an exchange of information with relatives appears essential, in particular when the patient cannot participate in the decision and when there are complex decisions to be made.

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Published

2022-04-01

How to Cite

Moutel, G., Goupille, P., Suzat, B., Rigaud, J.-P., Charvin, M., Grandazzi, G., Gouriot, M., Gakuba, C., Gaberel, T., & Benoist, G. (2022). Terminating a pregnancy in Intensive Care Unit without the patient’s consent: Ethical and medico-legal issues. Médecine Intensive Réanimation. https://doi.org/10.37051/mir-00095

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Original article

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