ETHICALLY JUSTIFIED CLINICALLY COMPREHENSIVE GUIDELINES FOR THE MANAGEMENT OF THE DEPRESSED PREGNANT PATIENT

OBJECTIVE: This article proposes ethically justified clinical guidelin es for managing depressed patients during pregnancy. STUDY DESIGN: We reviewed literature on depression and its consequences for pregnancy a nd related that literature to ethical principles. RESULTS: The health effects of depression on the pregnant woman and her fetus cannot be ma naged without consideration of the chronic and variable impairment of autonomy that may result from the effects of depression on the pregnan t woman's decision-making capacity. CONCLUSION: When the fetus is prev iable, recommendations concerning the disposition and prenatal diagnos is of the pregnancy should be nondirective, whereas strong treatment r ecommendations are justifiable if the pregnant woman has decided to co ntinue her pregnancy and is severely depressed. After viability, direc tive counseling for fetal benefit is ethically justified. The guidelin es focus on preventive ethics strategies to enhance the decision-makin g capacity of the depressed pregnant patient.