Janet M.

            Janet M., in her early twenties, is pregnant for the third time.  She has been an insulin-dependent diabetic since the age of 12 but has experienced no major complications of diabetes.

            Dr. Lambert has repeatedly advised her of the risks that uncontrolled diabetes poses to her fetus.  Congenital malformations are two to four times more common in infants of mothers whose diabetes is poorly controlled. Furthermore, uncontrolled diabetes can result in the birth of a premature, stillborn fetus. 

            Dr. Lambert admits her at 15 weeks gestation as an inpatient to treat her diabetes, but she discharges herself against his advice five days later before her diabetes has been satisfactorily controlled.  Once home, she ignores pleas from Dr. Lambert and other physicians to obtain chemstirps or a dextrometer for monitoring blood sugar.  In response, she tells them she ‘has no money’ or ‘forgot.’

            At 21 weeks gestation she is hospitalized for a threatened miscarriage but quickly announces her intention to leave.  Dr. L. decides that her behavior poses a clear risk to the well being of her fetus.  Unless she changes her mind, he says, he will seek a court order to keep her hospitalized. Is his response justified?

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-->Crigger, Bette-Jane. Cases in Bioethics : Selections from the Hastings Center Report. 3rd ed. New York: St. Martin's Press, 1998.