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Article   |    
Respecting the Autonomy of Chronic Mentally Ill Women in Decisions About Contraception
John H. Coverdale; Timothy L. Bayer; Laurence B. McCullough; Frank A. Chervenak
Psychiatric Services 1993; doi:
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Baylor College of Medicine in Houston; University of Auckland Medical School in Auckland, New Zealand

Baylor College of Medicine, 1 Baylor Plaza, Houston, Texas 77030

Center for Ethics, Medicine, and Public Issues at Baylor College of Medicine

Department of obstetrics and gynecology at the New York Hospital-Cornell Medical Center in New York City

1993 by the American Psychiatric Association

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Abstract

Treatment of women patients with chronic mental illness who are at risk of unwanted pregnancies presents ethical challenges to the clinician who wishes to respect the patient's autonomy while also helping her avert the potential adverse consequences of unwanted pregnancy. The clinician who simply allows the patient to continue at risk or coerces her into using contraception may not have adequately considered the variable nature of the patient's autonomy. The authors suggest that the clinician should assess and treat conditions underlying the patient's variable impairment of autonomy to maximize her ability to participate in family planning decisions. Case examples are used to illustrate assessment of patients' decision-making capacity, development of family planning approaches that respect patients' autonomy, and use of a newly available contraceptive implant.

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