Question

Mrs. Smith is an HIV-positive woman comes to labor and delivery at 40 weeks of pregnancy. She has a very low CD4 count (less than 50) and a high viral load (more than 500,000). You offer her a Caesarian section and intravenous zidovudine, which can cut the transmission rate in half even on the day of delivery. Mrs. Smith is anxious, but clearly has the capacity to understand the implications of this decision on both her health and the health of her child. She is still refusing the C-section and medications.

A) Respect her autonomy and continue with her chosen plan of care.
B) Override her decision and proceed with the recommended interventions.
C) Seek a court order to compel her to undergo the recommended procedures.
D) Discharge her from the hospital against medical advice.

Answer 1

Given Mrs. Smith's informed refusal, respecting her autonomy and proceeding with her chosen plan of care align with medical ethics.

Step-by-step explanation:

The subject of this question pertains to medical ethics and the management of a pregnant HIV-positive woman with a low CD4 count and high viral load. Given Mrs. Smith's condition, reducing mother-to-child HIV transmission is crucial. Methods for this include antiretroviral medications during pregnancy and to the infant after birth, cesarean delivery, and avoiding breastfeeding. Despite the recommendations for a Caesarian section and intravenous zidovudine to lower the transmission risk, Mrs. Smith refuses the interventions. In this situation, option A) respecting Mrs. Smith's autonomy and continuing with her chosen plan of care is aligned with the principles of bioethics, assuming she has been fully informed and is capable of making her own medical decisions.