, Volume 285, Issue 5, pp 1195-1203

Court-visited obstetrical and fertility procedures

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Abstract

Objective

To study proposals and benefits of the court-visited obstetrical and fertility interventions.

Methods

A total of 72 articles including 25 published decisions of the trial, circuit, appellate, and supreme courts are identified through the ACOG, RCOG, SOCG, and keyword search. The grounds of the hearings and their outcomes are modeled as measurable outcomes. The hearing counts are used as index units.

Results

Of the total adjudications reviewed, 28% are for criminal complaints and 72% for civil lawsuits. A substantial number of hearings (40%) concern mentally ill or impaired individuals. Among the hearings based on maternal–fetal conflicts, women’s autonomy is preserved in 25%, fetal rights are favored in 75%, and the rights of both are addressed in 6.25% of cases. Orders in favor of fetus are executed by coerced C-sections (20%), fetal custody (20%), and termination of parental rights (16%). The burden versus benefit ratio is 0.67 in the reviewed sample of coerced C-sections; 83.4% of the orders for involuntary sterilizations of mentally impaired are dismissed in favor of the constitutional rights (Amendments 1, 9, 14) and state mental health laws.

Conclusions

Court-ordered obstetrical procedures present an unsettled legal forum in terms of their complex interplay. The awareness of legal precedent can alert providers to possibility of an exception to the general presumption that the mother is competent, where it might trigger a legal or ethical council. Screening inventories (covering maternal–fetal attachment, judgmental fitness, prior obstetrical history, perinatal risk, formal/informal social support) jointly developed by the health providers and lawyers would assist involved parties in resolving complex situations without resorting to legal conflicts.