CLINICAL IMPLICATIONS OF RESPECT FOR AUTONOMY IN THE PSYCHIATRIC-TREATMENT OF PREGNANT PATIENTS WITH DEPRESSION

Major depression, as well as depressive symptoms that do not meet the full diagnostic criteria for a diagnosis of depression, can chronicall y and variably affect a woman patient's decisions about the management of pregnancy, including the decision about whether to continue a preg nancy. Depression also has potential adverse consequences for the preg nant woman and her pregnancy. However, little attention has been given to the ethical challenges posed by the psychiatric management of depr ession during pregnancy. The psychiatrist should balance respect for t he autonomy of the depressed woman with beneficence-based obligations to the pregnant woman, and also to the fetus, when the fetus is viable . The authors recommend strategies for assessing the decision-making a bilities of pregnant patients with depression and for enhancing their autonomy. They suggest that nondirective counseling should generally b e used with pregnant patients with depression when the fetus is previa ble and that directive counseling is ethically justifiable when the fe tus is viable.