The use of judicial process to force medical care on an unwilling patient has a
long and checkered history. It is a power that has been abused in the past and
will continue to be abused in the future. It is also a necessary power in the
management of persons who are not able to make rational decisions about
medical treatment. Most of these are chronically mentally ill, although some
are suffering from acute toxic or psychiatric conditions that render them
temporarily incompetent. The forced care of pregnant women is controversial
because it is being applied to women who are mentally competent. These
women may have made self- destructive decisions, but they are rational
decisions. The forced care is rationalized on the need to protect the fetus, not
the health of a woman who is unable to make rational medical care decisions.
The AMA policy emphasizes that the duty of private physicians is to inform and
educate their patients, not to make their decisions for them. (The duty of
certain public health and mental health physicians is to protect the public, even
at the derogation of an individual’s right to determine his or her own medical
care.) It is important to note that this presumes an informed refusal of medical
care. Patients who are not able to make rational decisions are not able to
make an informed refusal of medical care. In these cases, it is proper for the
court to intervene and ensure that the person receives proper medical care.
Physicians have the same duty to seek appropriate judicial intervention for a
mentally incompetent pregnant woman as for a mentally incompetent diabetic
man. They do not have the right to intervene to protect the health of the fetus
if the woman is otherwise competent to make her own health decisions.