This is the story of a patient that I saw today as a psychiatry consultation. Names are withheld, obviously, and details have been changed to preserve patient anonymity.
The patient is a 35 year old female, 31 weeks pregnant with twins. She was admitted to the hospital last night for premature labor.
A little background: she has four other children, ages 11 to 2, two of whom she lost custody of due to her abusive husband. She left him and has been in a spouse abuse shelter for four months now, and is trying to get the children back. She has no other family around, and no other contacts in town aside from the shelter.
At 31 weeks, the twins are significantly premature. They will probably make it, but they will be in intensive care for quite some time and face a good chance of long-term problems. The clear, medically sound decision is to delay labor.
However, she refuses. She believes that “God will take care of her”, and if it is God’s will that she should deliver now, so be it. She is fully aware of the risks to the children and is mentally sound. She is very distrustful of doctors, and has refused any medication, including insulin. (Did I mention she was diabetic? Mild and well-controlled with diet, though.)
The question–should the doctors have the right to override her religious beliefs and give her the medication anyway? I don’t exactly know the outlook for a 31 week preemie, much less a twin, (I haven’t had OB yet) but I think they’re likely to make it, with considerable effort and a good chance of long-term deficits.
Another question/can of worms–should money be a factor in the decision? I don’t like to think about financial concerns in medicine, but we’re talking about two NICU beds for what could be months. Does the fact that the hospital will be eating the cost of treatment give them any more say over the decision?
I had to leave before the saga came to a close. I’ll reserve my personal thoughts on the matter for a later post, since this one is long enough already.