Ethical Issues in Managing the Pregnancies of Patients with Schizophrenia

Objective: This paper identifies factors that contribute to the vulnerability of pregnant patients with schizophrenia and discusses the ethical issues in preventing and terminating pregnancies, managing labor and delivery, and treating psychosis during pregnancy. Method: PubMed and PsychINFO databases were searched using combinations of search terms including ethics, pregnancy, perinatal period and schizophrenia for relevant articles. In addition, an ethical framework was developed that was based on professional virtues, ethical principles of respect for autonomy and beneficence, the ethical concept of fetus as patient, and assisted and surrogate decision-making. Results: The processes of assisted decision-making constitute key components of the ethical framework and of professional responses to impairment in autonomy. These processes, which include education, skill training in problemsolving strategies, and treatment of psychosis and related conditions help women to regain capacity and to make prudent decisions based on their own long-standing values and beliefs. Psychiatry, family planning and sexual health services are integrated and coordinated to provide the requisite assessment, monitoring and protection of patients. Conclusions: Implementation of these recommendations should reduce the vulnerability of pregnant patients with schizophrenia and protect them from unwanted pregnancies and adverse pregnancy outcomes.