Major depression, as well as depressive symptoms that do not meet the
full diagnostic criteria for a diagnosis of depression, can chronically and
variably affect a woman patient's decisions about the management of
pregnancy, including the decision about whether to continue a pregnancy.
Depression also has potential adverse consequences for the pregnant woman
and her pregnancy. However, little attention has been given to the ethical
challenges posed by the psychiatric management of depression during
pregnancy. The psychiatrist should balance respect for the autonomy of the
depressed woman with beneficence-based obligations to the pregnant woman,
and also to the fetus, when the fetus is viable. The authors recommend
strategies for assessing the decision-making abilities of pregnant patients
with depression and for enhancing their autonomy. They suggest that
nondirective counseling should generally be used with pregnant patients
with depression when the fetus is previable and that directive counseling
is ethically justifiable when the fetus is viable.