A 22-year-old woman, gravida 1 para 0, comes to the office after a positive home pregnancy test. Her last menstrual period was approximately 9 weeks ago. The patient recently moved from out of town to start graduate school and does not have a local health care provider. She has no medical history and takes no medications. She does not use tobacco, alcohol, or illicit drugs. Pelvic examination shows an anteverted, enlarged uterus. Ultrasound confirms a 9-week intrauterine gestation with normal cardiac activity. When the patient sees the results of the ultrasound, she requests a termination of pregnancy. The office does not offer pregnancy termination services due to religious beliefs. What is the best response to this patient?

Question

A 22-year-old woman, gravida 1 para 0, comes to the office after a positive home pregnancy test.  Her last menstrual period was approximately 9 weeks ago.  The patient recently moved from out of town to start graduate school and does not have a local health care provider.  She has no medical history and takes no medications.  She does not use tobacco, alcohol, or illicit drugs.  Pelvic examination shows an anteverted, enlarged uterus.  Ultrasound confirms a 9-week intrauterine gestation with normal cardiac activity.  When the patient sees the results of the ultrasound, she requests a termination of pregnancy.  The office does not offer pregnancy termination services due to religious beliefs.  What is the best response to this patient?

Quizplus · Accepted Answer

Conscientious refusal occurs when a provider refuses to provide care because doing so would conflict with the provider's beliefs. Although following one's conscience-the part of the self that judges actions as right or wrong-can lead to ethical and appropriate care, it also can conflict with professional obligations. Provider conscience does not take precedence over other ethical principles (eg, autonomy, justice, beneficence, nonmaleficence). Providers who are unable to provide care in good conscience are professionally and ethically obligated to refer patients in a timely fashion to other providers who can provide care. (Choice A) Although abortion management is associated with some risks, overstating the risk of a procedure violates patient autonomy. Regardless of moral beliefs, patients should be provided accurate, unbiased information to make medical decisions. (Choices B, C, and F) Making the provision of care dependent on the patient's decision to terminate the pregnancy violates patient autonomy. Referring the patient to an adoption agency risks imposing provider beliefs (eg, that adoption is preferable to termination) on the patient. The principle of patient autonomy involves affirming patient decision-making capacity and avoiding the imposition of provider beliefs on the patient. (Choice D) Asking the patient to explain or justify her request for a termination can be perceived as disrespect for patient autonomy. "Why" questions should be avoided as they are viewed negatively by patients and cause them to become defensive of their choices or actions. Educational objective: Conscientious refusal of treatment occurs when a provider refuses to provide care due to moral conflict. Providers who cannot, in good conscience, provide treatment that a patient requests, are obligated to refer the patient in a timely fashion to another provider who can. References: ACOG committee opinion no. 385 November 2007: the limits of conscientious refusal in reproductive medicine. (http://www.ncbi.nlm.nih.gov/pubmed/17978145)

A 22-Year-Old Woman, Gravida 1 Para 0, Comes to the Office