Ethically justified clinically comprehensive guidelines for the management of the depressed pregnant patient.

Abstract

This article proposes ethically justified clinical guidelines for managing depressed patients during pregnancy. We reviewed literature on depression and its consequences for pregnancy and related that literature to ethical principles. The health effects of depression on the pregnant woman and her fetus cannot be managed without consideration of the chronic and variable impairment of autonomy that may result from the effects of depression on the pregnant woman's decision-making capacity. When the fetus is previable, recommendations concerning the disposition and prenatal diagnosis of the pregnancy should be nondirective, whereas strong treatment recommendations are justifiable if the pregnant woman has decided to continue her pregnancy and is severely depressed. After viability, directive counseling for fetal benefit is ethically justified. The guidelines focus on preventive ethics strategies to enhance the decision-making capacity of the depressed pregnant patient.