title: A suicidal pregnant patient's request for premature Cesarean section: Clinical and ethical challenges.
abstract: We present the case of a 36-year-old lady with severe borderline personality disorder and depression, who made repeated requests for an immediate Cesarean section at 31 weeks of gestation. Her mood was extremely depressed and she had intense suicidal thoughts. She was worried that she would kill herself and the baby, therefore believing that early delivery would save the baby's life. This was a challenging case that required multidisciplinary collaboration, suicide risk assessment and detailed evaluation of mental capacity. The clinical and ethical dilemmas of this case are discussed by a team of psychiatrists, obstetricians and neonatologists.
authors.affiliation: Department of Psychological Medicine, National University Hospital, Singapore. Electronic address: jia_ying_teng@nuhs.edu.sg.
authors.forename: Jia Ying
authors.initials: JY
authors.lastname: Teng
authors.affiliation: Department of Psychological Medicine, National University Hospital, Singapore.
authors.forename: Cornelia
authors.initials: C
authors.lastname: Yin Ing Chee
authors.affiliation: Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore.
authors.forename: Yap-Seng
authors.initials: YS
authors.lastname: Chong
authors.affiliation: Department of Neonatology, Khoo Teck Puat - National University Children's Medical Institute, National University Hospital, Singapore; Department of Paediatric Medicine, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore.
authors.forename: Le Ye
authors.initials: le Y
authors.lastname: Lee
authors.affiliation: Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore.
authors.forename: Eu Leong
authors.initials: EL
authors.lastname: Yong
authors.affiliation: Department of Obstetrics and Gynaecology, National University Hospital, Singapore.
authors.forename: Claudia
authors.initials: C
authors.lastname: Chi
authors.affiliation: Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore; Singapore Institute for Clinical Sciences, the Agency for Science, Technology and Research, Singapore.
authors.forename: Birit
authors.initials: B
authors.lastname: Broekman
mesh_terms: D000328:Adult; D001883:Borderline Personality Disorder / Q000453:epidemiology / Q000523:psychology; D002585:Cesarean Section; D003866:Depressive Disorder / Q000453:epidemiology / Q000523:psychology; D004992:Ethics, Medical; D005260:Female; D006801:Humans; D057240:Patient Preference; D011247:Pregnancy; D037841:Pregnant People / Q000523:psychology*; D059020:Suicidal Ideation
keywords: Borderline personality disorder; Depression; Pregnancy; Suicidal