Resolution of Ethical Dilemmas Using Basic Ethical Principles in Cases of Pregnancy with Severe Symptoms of Coronavirus Disease 2019 Complications

Taufik Suryadi; Sarjani Sarjani; Kulsum Kulsum

doi:10.3889/oamjms.2021.7486

Authors

Taufik Suryadi Department of Forensic Medicine and Medicolegal, Faculty of Medicine, Universitas Syiah Kuala,The Zainoel Abidin Hospital, Banda Aceh, Indonesia; Ethics and Medicolegal Consultant, Faculty of Medicine, Universitas Syiah Kuala,The Zainoel Abidin Hospital, Banda Aceh, Indonesia
Sarjani Sarjani Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Syiah Kuala,The Zainoel Abidin Hospital, Banda Aceh, Indonesia
Kulsum Kulsum Department of Anesthesiology and Intensive Therapy, Faculty of Medicine, Universitas Syiah Kuala,The Zainoel Abidin Hospital, Banda Aceh, Indonesia

DOI:

https://doi.org/10.3889/oamjms.2021.7486

Keywords:

Basic ethical principles, COVID-19, Ethical dilemma, Termination of pregnancy

Abstract

BACKGROUND: Coronavirus disease 2019 (COVID-19) can attack the entire population, but is more aggressive in vulnerable populations such as the elderly, patients with chronic diseases, and pregnant women. For pregnant women, the management of COVID-19 treatment provided must be in line with efforts to reduce maternal mortality. The method of this study was a case report. A pregnant woman aged 40 years who was confirmed with severe COVID-19 symptoms. This patient had severe symptomatic hypoxemia and had a hypercoagulable state. Termination of pregnancy in patients is considered for the sake of fetomaternal safety so that an ethical dilemma arises. For this reason, a joint conference was held to get the best solution for the patient and the fetus.

CASE REPORT: Using several basic ethical principles such as beneficence, nonmaleficence, justice, and autonomy, which are supported by the principles of minus malum, double effect, and prima facie, it was decided for the patient to terminate pregnancy to reduce severe symptoms of COVID-19. Termination of pregnancy in pregnant women with confirmed COVID-19 with severe symptoms is still an ethical dilemma that needs to be discussed further. Therefore, ethical considerations in this patient were carried out by reviewing obstetric, pediatric, pulmonology, anesthesia, and internal medicine indications.

CONCLUSION: Termination of pregnancy in this patient with confirmed COVID-19 with severe symptoms can be done. Although termination of pregnancy has not completely saved the mother’s condition, this decision has the potential to provide benefits and safety for the patient and the fetus.

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