Does Pregnancy Bias Medical Ethical Decision Making? • 230

Abstract

When faced with questions concerning the treatment of critically ill or malformed neonates, pregnant women naturally tend to identify with and personalize the issues. We hypothesized, therefore, that women would respond differently to questions concerning medical ethical decision making when pregnant than when postpartum. Methodology We surveyed the attitudes of both pregnant and postpartum women via comprehensive questionnaires which were divided into three sections: 1)sociodemographic; 2)case scenarios- parents were asked to select one of three treatment options for hypothetical cases of neonates with problems; and 3)philosophic principles- parents were asked to grade various theoretical factors as to their importance in influencing medical ethical decision making.Results Both populations were similar sociodemographically. During pregnancy, women were less likely to request maximally aggressive care when dealing with the case scenarios (table). They were less likely to want life preserved at all cost (67% vs 76%; p=0.02); and more likely to consider prognosis for future productivity (91% vs 84%; p=0.009) and pain and suffering of the infant (87% vs 78%; p=0.003) as extremely important in influencing decision making than were postpartum women.Conclusion Responses of pregnant women to questions of medical ethical decision making were quite different from those of postpartum women. They consistently and significantly requested less aggressive medical care for critically ill or malformed infants; were more concerned with the infants' physical pain and with prognosis for the future; and were less concerned with preserving life at all cost. We speculate that the differences observed reflect the intense personalization with which pregnant woman related to the cases. Once postpartum, ie. comfortable in the knowledge that their baby was born healthy, the women dealt with the questions in a more theoretical framework.