Many physiologic conditions make pregnancy dangerous to the mother and the
baby. Most of these, such as diabetes, are intrinsic and, except for compliance
issues, beyond the control of the woman. Some, such as alcoholism or cocaine
use, are behavioral problems with substantial voluntary components. An
unfortunate nexus of the medical efforts to improve prenatal health and the
political debate on whether the fetus is a person deserving independent
protection is the pregnant woman who engages in activities that might harm
her fetus. Such women have been subjected to forced medical care, including
Cesarean sections, and to incarceration in prison.
Debates over the legality and even the usefulness of coercive policies aimed at
pregnant women have obscured the issues in managing high-risk pregnancies.
There is vast gulf between a physician seeking to have a woman treated
against her will and the much more common problem of helping a patient
understand the risks and benefits of various behaviors and medical care
alternatives. In general, physicians providing personal health services should
not attempt to force unwanted medical care on their pregnant patients. The
American Medical Association’s (AMA’s) position is illustrative.