Compounding Vulnerability: Pregnancy and Schizophrenia

The predominant ethical framework for addressing reproductive decisions in the maternal–fetal relationship is respect for the woman's autonomy. However, when a pregnant schizophrenic woman lacks such autonomy, healthcare providers try to both protect her and respect her preferences. By delineating etic (objective) and emic (subjective) perspectives on vulnerability, I argue that options which balance both perspectives are preferable and that acting on etic perspectives to the exclusion of emic considerations is rarely justified. In negotiating perspectives, we balance the etic commitment to protect the vulnerable patient and her fetus from harm with the emic concern to empower a decisionally incapacitated woman. Equilibrium is best achieved by nurturing interdependent relationships that empower and protect the vulnerable woman. The analysis points to the need for better social support for mentally ill patients.

Keywords:

• clinical ethics
• vulnerability
• integrity
• schizophrenia
• decision-making capacity
• maternal-fetal relationship

ACKNOWLEDGMENTS

The author is grateful to those involved in Rebecca's care Nancy Jecker, PhD, Mark Sullivan, MD, PhD, and anonymous reviewers.

Notes

1. Non-essential aspects of the case and all names have been changed. For discussion of this case absent the vulnerability framework outlined in this article, see Dudzinski and Sullivan 2004.