This paper had identified a contemporary ethicolegal dilemma concerning the circumstances, if any, in which a pregnant woman's refusal of medical treatment may be judicially overridden either in her interests or those of the unborn child. On the one hand, the obstetrician will be concerned about the interests of both his patients in potentially life-threatening situations when they can be protected by what might be regarded as relatively straightforward procedures and where to fail to take those steps might expose the practitioner (at least outside New Zealand where its accident compensation legislation has impact in this regard) to allegations of negligence. On the other hand, the imposition of treatment in these circumstances will necessarily interfere with the woman's rights of autonomy and self-determination. In such cases also, the conduct of medical procedures in the face of an express prohibition by the woman may give rise to liability for battery. (In New Zealand, such a potential liability would not, in the writer's view, be affected by the prohibition on proceedings for damages for medical misadventure as contained in the Accident Rehabilitation and Compensation Insurance Act 1992.) At the heart of an analysis of this issue is the status of the fetus as it is the fact of the woman patient's pregnancy which distinguishes the cases discussed in this paper from others in which the Courts have had to deal with refusals of treatment by those competent to do so. In regard to this aspect, the approach of the Courts in various jurisdictions has arguably been confused and contradictory.(ABSTRACT TRUNCATED AT 250 WORDS)
PIP: This article reviews and analyzes US and UK court decisions concerning the circumstances (if any) in which medical treatment of a pregnant woman is lawful in the absence or refusal of consent. This issue is of practical importance to physicians and raises ethicolegal issues about the relative and competing rights of a pregnant woman and the fetus. A brief overview is provided of the general principles of consent and relevance, and situations in which the "doctrine of necessity" (which allows treatment to be given without consent) may and may not be invoked are outlined. The general status of the fetus as contained in relevant civil law and the right of the fetus to sue as a result of injury inflicted in utero are then reviewed in light of key decisions made in England and Australia. Court decisions on whether a fetus can be "warded" and placed under an order of guardianship are also reviewed. Three US cases in which the courts were asked to override a pregnant woman's refusal to consent to treatment are then detailed. In one case, the pregnant woman was ordered to undergo a sonogram and to submit to a Cesarean section if the placenta was still malpositioned. In a second case, a Cesarean was ordered for a woman near death from cancer. This action was overturned after the fact (and the woman's and baby's deaths) by an appeals court. In the third case, the court refused to order a Cesarean section when doctors predicted the fetus would not otherwise survive. In Britain, the court allowed a blood transfusion to a lapsed Jehovah's Witness who was comatose and had miscarried as the result of a traffic accident. The second case, in which the ruling has been criticized, permitted a Cesarean in a woman whose fetus was malpositioned. These rulings have centered on the status of the fetus and have, therefore, suffered from confusion. They have also suffered from hasty decisions made in perceived emergency situations. In the US, maternal rights are outweighing fetal rights. It has been concluded that courts should not compel pregnant women to submit to medical treatment and any judicial authority in these matters should arise from legislation.