Maternal-Provider Capacity: What to Do When a Patient Who Lacks Capacity Refuses Induction of Labor Following Intrauterine Fetal Demise?

Abstract: In this presentation I present the case of a pregnant patient who experienced fetal demise. The patient had a history of schizophrenia and lacked insight into her condition. Specifically, she believed that her baby was alive and that the care team wanted to take her baby from her to kill them. For this reason, she refused the care team’s recommendation to evacuate the deceased fetus.

New York State, where this encounter occurred, requires a court order to treat patients over objection even when they lack capacity. Because this was not a medical emergency—the fetus would have to be evacuated eventually, but the patient was in no imminent danger—the care team was required to honor her refusal or go to court. The hospital’s legal counsel advised that the hospital might not prevail in court because there was no medical emergency, and that the hospital had no legal basis for holding the patient (who was unhoused and unlikely to voluntarily return) against her will.

I argue that this case raises ethical challenges that are structurally similar to the criticisms that organizations like ACOG have raised against narrow exceptions to abortion bans in states like Texas. In these cases, patients and providers may be required to wait until a pregnancy becomes life-threatening in order to legally terminate it, putting the patient’s health at risk. I examine whether this harmful delay argument supports revising New York State’s requirement that hospitals seek a court order to treat patients who lack capacity over objection.