Published ahead of print on November 16, 2006, doi:10.1164/rccm.200605-598OE
© 2007 American Thoracic Society doi: 10.1164/rccm.200605-598OE
Pregnancy and Chronic Progressive Pulmonary Disease1 Department of Pediatrics, Hadassah University Hospital, Mount Scopus, Hebrew University Hadassah Medical School, Jerusalem, Israel; 2 Department of Women's and Children's Health, Uppsala University, Uppsala University Hospital, Uppsala, Sweden; 3 Adult Cystic Fibrosis Unit, Northern General Hospital, Sheffield, United Kingdom; and 4 CF Legal Information Hotline, Houston, Texas Correspondence and requests for reprints should be addressed to Eitan Kerem, M.D., Director, Department of Pediatrics and CF Center, Hadassah University Hospital—Mount Scopus Campus, Hadassah Hebrew University Medical Center, Jerusalem 91240, Israel. E-mail: kerem{at}hadassah.org.il ABSTRACT Progressive pulmonary disease may preclude the option of pregnancy for a number of women in their child-bearing years due to the severity of the disease. For a subset of women with chronic lung disease including cystic fibrosis, pregnancy is possible, but can have a devastating effect both on the prospective mother and fetus. The potential hazards of pregnancy in cystic fibrosis or other progressive pulmonary diseases may trigger a moral conflict between physician and patient. The female patient may argue that her autonomy cannot be circumscribed and that the physician is obliged to assist her reproductive efforts. The physician can counter that his/her participation in potentially harmful interventions is not consistent with professional norms requiring adherence to the principles of beneficence and nonmaleficence. Whenever possible, the ethical conflict between physician and patient should be resolved before initiation of pregnancy. We propose that this best be done through structured negotiations between physician and patient with the goal of constructing an ethical framework for reducing the moral tension between the two. Steps in the negotiating process include defining the therapeutic alliance, information exchange, dialog, and deliberation. As part of the information exchange, it is important to discuss alternatives to pregnancy such as adoption and surrogacy, especially when there are strong contraindications to pregnancy. If negotiations reach a satisfactory conclusion for both sides, there should be a well-delineated consensual agreement to commence the pregnancy with the full support of the medical team.
Key Words: pulmonary disease • cystic fibrosis • pregnancy • patient autonomy • beneficence This article has been cited by other articles:
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