Navigating Uncertainty in Decision-Making and Challenges to Healthcare Access Following Diagnosis of Fetal Anomaly: Bioethics and Social Factors Impacting Patient Decision-Making.

Pregnant patients weigh many factors when deciding whether to continue a pregnancy with fetal anomaly, including their family context, access to resources, and barriers to healthcare. We explore the social factors and bioethical issues that affect decisions to continue a pregnancy with fetal anomaly, illustrated by our patient's experience of heteropagus twin pregnancy. The patient had to decide whether to undergo delivery and newborn surgery out-of-province, weighed against leaving her special needs child, and limited social supports. We analyze the relevant bioethical concepts: autonomy, justice, relational ethics, and relational autonomy. Physicians who consider these stressors and bioethical issues may better appreciate and support their pregnant patients' decision-making.