Ethical Decisions in Pregnancy

  • Thomas I. CochraneEmail author


Decision-making for pregnant women or fetuses who suffer brain injury is emotionally difficult and conceptually challenging. When both the pregnant woman and the fetus have suffered an injury with a poor neurological prognosis, and decisions about one of them will have implications for the other—decision-making is even more difficult. Decision-making standards and principles are reviewed for both pregnant women and for fetuses, using a real case from the author’s institution. Practical suggestions are made regarding deliberative processes and consultative models that can help with these difficult cases.


Ethics Brain injury End-of-life decisions Pregnancy Life-sustaining therapy 


  1. 1.
    Beauchamp TL, Childress JF. A framework of standards for surrogate decision making. In: Pierce J, Randels G, editors. Contemporary bioethics. New York: Oxford University Press; 2012.Google Scholar
  2. 2.
    Beauchamp TL, Childress JF. Principles of biomedical ethics. 7th ed. New York: Oxford University Press; 2012.Google Scholar
  3. 3.
    Ringer S. Neonatal Intensive Care Unit (NICU) ethics. In: Toy E, Raine SP, Cochrane T, editors. Case files: medical ethics and professionalism. New York: McGraw Hill; 2015. p. 267–277.Google Scholar
  4. 4.
    Hagen EM, Therkelsen OB, Forde R, Aasland O, Janvier A, Hansen TW. Challenges in reconciling best interest and parental exercise of autonomy in pediatric life-or-death situations. J Pediatr. 2012;161:146–51.CrossRefGoogle Scholar
  5. 5.
    Harrison H. The offer they can’t refuse: parents and perinatal treatment decisions. Semin Fetal Neonatal Med. 2008;13:329–34.CrossRefGoogle Scholar
  6. 6.
    McHaffie HE, Laing IA, Parker M, McMillan J. Deciding for imperiled newborns: medical authority or parental autonomy? J Med Ethics. 2001;27:104–9.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Brigham and Women’s Hospital, Center for Bioethics, Harvard Medical SchoolBostonUSA

Personalised recommendations