ACOG Issues Committee Opinion Regarding Refusal of Recommended Treatment

What happens when a pregnant woman refuses treatment that a provider believes is beneficial to both her and the fetus? The American College of Obstetricians and Gynecologists just issued a new Committee Opinion on just this topic (ACOG No. 664). According to ACOG, the committee opinion was necessary to address the balance between the provider’s “ethical obligation to safeguard the pregnant woman’s autonomy” and the “ethical desire to optimize the health of the fetus.” In the Opinion, ACOG opposes “forced compliance,” which it defines as “the alternative to respecting violations of bodily integrity, power differentials, and gender equality.”

The Committee opined that, in general, a pregnant woman has the right to refuse treatment, even if that treatment is needed to maintain life. The Committee encourages providers to engage in active dispute resolution when the woman refuses treatment, including “eliciting the patient’s reasoning, lived experience, and values.” The Committee warns against providers evoking “conscience as a justification to attempt to coerce a patient into accepting care that she does not desire.”

The Committee Opinion appears to be part of a larger movement related to patient autonomy, recognition of a category known as “obstetric violence,” and updating the Hippocratic charge for the provider for the modern age.

Partner Eric Frisch is speaking on this topic at the ACI Conference on Obstetrics and Gynecology legal issues on June 22-23 in Philadelphia.

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