Reproductive Choices and Informed Consent: Fetal Interests, Women's Identity, and Relational Autonomy

Abstract

In this Article, I describe and examine the severe shortcomings in women's autonomy in the context of reproductive choices in the medical arena. The reproductive choices I explore are those choices that involve gestation: abortion, fertility treatments, and interventions during pregnancy. Due to state and medical interests in the fetus, I describe how information conveyed to patients making reproductive choices is biased towards fetal interests, relies on female stereotypes, and is still conveyed with the objective authority of the medical profession. Moreover, reproductive choices implicate women's values and identity interests that reach beyond medical concerns, which are not part of the informed consent doctrine at all. The narrow, individualistic informed consent torts doctrine intended to protect patient autonomy does not do enough in this context to balance bias nor does it mandate discussion of important identity interests and values. Accordingly, I argue that when faced with reproductive choices, women are not provided the balanced and comprehensive information needed to promote their autonomy. In response to the breakdown in patient autonomy I describe, instead of leaving women alone to make choices or regulating in order to protect them from their choices, a broader framework for supporting reproductive choices should be established. In light of the interdependence of woman and fetus, as well as the broader social context shaping these decisions, I argue that a more contextual, relational perspective of autonomy should be the goal of informed consent in the context of reproductive choices. I suggest a number of reforms that aim to optimize patient autonomy from a relational perspective. I suggest a broad, deliberative doctor-patient consultation and legal reforms that create more balance between the pull towards intervention and fetal protection on the one hand, and non-intervention and protection of women's personal identity interests on the other.

Informed Consent

“…Contrary to this, P Laufer-Ukeles advocated the taking of consent from the women even for their reproductive choices. 17 Denying female patients for the consent could be due to the fact that a large proportion of emergency patients felt frightened or under pressure when signing the form as was concluded by Akkad, Andrea, et al 18 This could be due to the fact that the obstetrics and gynecology patients were unaware of the legal implications of their opinions &written consent. 19 We found a lack of communication between general practitioners & their patients that needs to be improved Nievelstein et al also concluded in a research on this issue that efforts should be directed towards improved information and communication between the doctors & patients for the betterment of the patients.…”

Feminist Perspectives in Health Law

“…For example, Pamela Laufer-Ukeles has critiqued the narrowness of the informed consent doctrine in the context of reproductive choices, noting that it ignores the political and public context of abortion and other reproductive decision-making. 31 She suggests that “relational autonomy … be used to transform the informed consent process into a more balanced and comprehensive consultation that better supports women's autonomy in the context of reproductive choices.” 32…”

Getting the ‘Comfortable’ to listen: a mixed methods study of refusal of recommended maternity care

“…Case law around the right to refuse medical treatment (discussed further below) reflects an individualistic account of autonomy (Wade, 2014), but some feminists have criticised this approach. When reproductive choices are framed as private and individualistic, it obscures the social context in which women make decisions (Laufer-Ukeles, 2011). This social context includes the woman's relationships "with the fetus, her doctor, midwife, partner, family, friends and society as a whole" (Thachuk, 2007, p. 42).…”

“…Rather than constructing the pregnant woman as a threat to her fetus, who is then in need of rescue by paternalistic clinicians, a "wider gaze" is needed (Harris, 2000, p789). By understanding the social and family relationships, context and constraints on woman's decision making, the pregnant woman and fetus retain their status as a single unit, with fetal well-being best protected by supporting maternal well-being (Harris, 2000;Laufer-Ukeles, 2011). This reflects feminist understandings of autonomy as a relational, rather than individualistic, construct and underpins a broad, comprehensive and bias-and conflict-aware account of refusal (Laufer-Ukeles, 2011).…”