In clinical situations such as these, where decision making must somehow account for multiple competing values, no one person can claim to be arbiter of what is ‘ethical.’ People may defensibly come to different answers when considering the same values based question. However, ethics requires us to rely on a rigorous process and defensible rationale for how and why we made the value judgement in that particular circumstance we face.

The gold standard in how decisions are arrived at in complex clinical situations such as these is ‘shared decision-making.’ Each stakeholder with their particular expertise should be involved in a shared and iterative decision-making process, sorting through relevant data and values together, ideally aimed at coming to a consensus about the next best step in the particular circumstance. The haematologist is responsible for determining what treatment he is prepared to offer, but this can sometimes change during the shared decision-making process as other important information, including the patients’ goals and values, are brought to light.

Ultimately, it is Karin’s decision to accept or refuse the treatments offered to her based on her own goals and values. Her decision must also be informed, which requires evidence-based information provision regarding relevant risks/benefits.

In NSW, it is clear that legally the health practitioner’s duty of care relates to the pregnant woman only, and the fetus is not accorded legal rights until it is born. In some places it is a criminal offence to cause harm to a fetus. Read more.

Ethically, the woman’s partner or husband has a stake in the decision making process. However, it’s the pregnant woman’s goals and preferences that are ultimately guiding.

“That a husband or partner has a stake in the decision-making process of the pregnant woman does not, however, establish his or her controlling authority over the pregnant woman”
(Talbot & Norman [2012] FamCA 96).