When patients change their minds after starting an abortion: Guidance from the National Abortion Federation’s Clinical Policies Committee

Mark, Alice; Grossman, Daniel; Foster, Angel M.; Prager, Sarah; Winikoff, Beverly

doi:10.1016/j.contraception.2020.01.016

Cited by 4 publications

(5 citation statements)

References 16 publications

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“…Although substituted judgment from a surrogate decision-maker is well established as an ethical standard, surrogates may be biased by their own values and preferences, and even well-intentioned surrogates may not correctly identify what the pregnant patient would want for herself. 31 Given that some pregnant women with full decisional capacity change their minds about termination even after initiating the termination process, 34 surrogates may also understandably feel uncertain when faced with the decision to continue or terminate a pregnancy in a woman with psychosis. Pregnancy termination without a patient’s consent could result in serious, irreversible, and far-reaching consequences, including long-term psychological trauma if the patient recovers from her psychosis, becomes cognizant of the termination, and subsequently identifies the terminated pregnancy as a desired pregnancy.…”

Section: Discussionmentioning

confidence: 99%

Ethical considerations in the treatment of chronic psychosis in a periviable pregnancy

et al. 2022

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Background: Treatment of psychotic disorders in pregnancy is often ethically and clinically challenging, especially when psychotic symptoms impair decision-making capacity. There are several competing ethical obligations to consider: the ethical obligation to maternal autonomy, the maternal and fetal beneficence-based obligations to treat peripartum psychosis, and the fetal beneficence-based obligation to minimize teratogenic exposure. Objective: This article outlines an ethical framework for clinical decision-making for the management of chronic psychosis in pregnancy, with an emphasis on special considerations in the previable and periviable period. Case Presentation: A 31-year-old gravida 2, para 1 with intrauterine pregnancy at 12 weeks and 4 days gestation was brought to the emergency department by her husband seven months after delivering her first child, due to sudden onset of behavioral changes that included self-isolation, not eating, and not taking care of her child. Her past medical history included hypothyroidism and inflammatory bowel disease, but no prior psychiatric illness. After being admitted to the psychiatric hospital, she continued to have poor oral intake and weight loss despite initial inpatient treatment with antipsychotics, levothyroxine, and discontinuation of corticosteroids. Her pregnancy was also complicated by the diagnosis of multiple fetal anomalies at 20 weeks gestation, when the fetus was periviable. Conclusions: For previable or periviable pregnancies, the patient and/or surrogate should decide whether to pursue prenatal genetic screening and invasive diagnostic testing, as well as whether to continue or terminate the pregnancy. When the choice is made to continue the pregnancy, initiation of long-term psychiatric treatment (including medications with potential adverse fetal effects) should be based on shared decision-making between the physician and the patient and/or surrogate. Although some pharmacologic interventions may have potential adverse effects on the developing fetus, the use of psychotropic medications can be ethically justified, even if the patient herself does not have the capacity to consent and requires a surrogate, when the goal is to restore maternal autonomy and minimize the risks of maternal and fetal harm from untreated psychiatric illness.

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Section: Discussionmentioning

confidence: 99%

Ethical considerations in the treatment of chronic psychosis in a periviable pregnancy

et al. 2022

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“…And, guidelines from ACOG and various other major medical societies include recommendations for Rh D immune globulin prophylaxis for Rh D-negative patients undergoing medication abortion within the first 12 weeks of gestation [44,[58][59][60]. For patients undergoing medication abortion before 10 weeks of gestation, some experts recommend against routine Rh testing and anti-D prophylaxis [6] or advise that forgoing Rh typing and Rh prophylaxis can be considered [61]. Research regarding Rh alloimmunization during early pregnancy continues to evolve [62].…”

Section: What Evaluation and Ancillary Testing Is Needed Before A Medmentioning

confidence: 99%

Medication Abortion Up to 70 Days of Gestation

2020

Obstetrics &Amp; Gynecology

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Medication abortion, also referred to as medical abortion, is a safe and effective method of providing abortion. Medication abortion involves the use of medicines rather than uterine aspiration to induce an abortion. The U.S. Food and Drug Administration (FDA)-approved medication abortion regimen includes mifepristone and misoprostol. The purpose of this document is to provide updated evidence-based guidance on the provision of medication abortion up to 70 days (or 10 weeks) of gestation. Information about medication abortion after 70 days of gestation is provided in other ACOG publications [1].

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“…And, guidelines from ACOG and various other major medical societies include recommendations for Rh D immune globulin prophylaxis for Rh D-negative patients undergoing medication abortion within the first 12 weeks of gestation (44, 58-60). For patients undergoing medication abortion before 10 weeks of gestation, some experts recommend against routine Rh testing and anti-D prophylaxis (6) or advise that forgoing Rh typing and Rh prophylaxis can be considered (61). Research regarding Rh alloimmunization during early pregnancy continues to evolve (62).…”

Section: Teratogenicity and Ongoing Pregnancymentioning

confidence: 99%

Medication Abortion Up to 70 Days of Gestation

2020

Contraception

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When patients change their minds after starting an abortion: Guidance from the National Abortion Federation’s Clinical Policies Committee

Cited by 4 publications

References 16 publications

Ethical considerations in the treatment of chronic psychosis in a periviable pregnancy

Ethical considerations in the treatment of chronic psychosis in a periviable pregnancy

Medication Abortion Up to 70 Days of Gestation

Medication Abortion Up to 70 Days of Gestation

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