Respecting the autonomy of chronic mentally ill women in decisions about contraception.
Treatment of women patients with chronic mental illness who are at risk of unwanted pregnancies presents ethical challenges to the clinician who wishes to respect the patient's autonomy while also helping her avert the potential adverse consequences of unwanted pregnancy. The clinician who simply allows the patient to continue at risk or coerces her into using contraception may not have adequately considered the variable nature of the patient's autonomy. The authors suggest that the clinician should assess and treat conditions underlying the patient's variable impairment of autonomy to maximize her ability to participate in family planning decisions. Case examples are used to illustrate assessment of patients' decision-making capacity, development of family planning approaches that respect patients' autonomy, and use of a newly available contraceptive implant.
Coverdale
J H
JH
Baylor College of Medicine, Houston, TX 77030.
Bayer
T L
TL
McCullough
L B
LB
Chervenak
F A
FA
D000328:Adult; D016223:Advance Directives; D026686:Beneficence; D002908:Chronic Disease; D003268:Contraception Behavior; D004992:Ethics, Medical; D005260:Female; D005783:Gender Identity; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007258:Informed Consent / Q000331:legislation & jurisprudence; D001523:Mental Disorders / Q000523:psychology* / Q000534:rehabilitation; D028642:Persons with Psychiatric Disorders; D016487:Parenting / Q000523:psychology; D026706:Paternalism; D010344:Patient Advocacy; D026684:Personal Autonomy; D011247:Pregnancy; D018570:Risk Assessment; D012307:Risk Factors; D012559:Schizophrenia / Q000534:rehabilitation; D012565:Schizophrenic Psychology