The physician’s duty to inform and educate is the same whether the factor
complicating the pregnancy is intrinsic or behavioral. This duty is complicated
by the legal dilemma that the woman is the proper arbitrator of her medical
care, but she is not the only person who can sue the physician for the
consequences of that care. The patient’s husband or surviving children can sue
the physician if the patient dies or is gravely injured. If the woman knowingly
assumes the risk of the pregnancy and her medical decisions, then she can
waive her right to sue. This waiver will bar others who might sue on her behalf
or on their own behalf because of their suffering occasioned by her injuries.
The patient’s assumption of risk (or informed consent) is effective only if it is
carefully obtained and documented. The risks to the patient and to the baby
must be fully explained and the explanation documented. This is best done
with a structured prenatal care system, tailored to the patient’s special needs.
Dilemmas arise because the law is ambiguous about a woman’s right to
assume the risk of injury for her fetus. Although it is expected that the courts
will not hold a physician liable when a woman clearly refuses care, the burden
will be on the physician to convince the jury that the refusal was both knowing
and unshakable. Juries assume that patients are rational and refuse care only
if they are insufficiently informed of the risks. Juries will have a stronger
prejudice that a pregnant woman would not knowingly have put her baby at
risk. Although it may be easy to convince a jury that a woman who uses crack
does not care about her baby’s well-being, it will be much harder to convince
them that refusing medical care evidences the same level of disregard.