A Mother in Jeopardy: The Ethics of Pregnancy and Chemotherapy.

Document Type

Article

Publication Date

1-1-2020

Publication Title

The American journal of hospice & palliative care

Keywords

Adenocarcinoma; Adult; Antineoplastic Agents; Ethics, Medical; Female; Humans; Ovarian Neoplasms; Pregnancy; Spirituality

Abstract

JM is a 32-year-old primagravida with polycystic ovary disease. She had extreme difficulty conceiving and was started on clomiphene 6 months ago by her fertility specialist. After doubling the dose on the sixth cycle, she successfully became pregnant. On her second prenatal visit at 12 weeks gestation, an ovarian cyst was detected. Ultrasound showed a complex ovarian mass with nodules on the bowel and abdominal wall. There was mild-to-moderate peritoneal fluid. Cytology showed adenocarcinoma of ovarian origin. Further workup demonstrated advanced stage III epithelial ovarian cancer. JM was referred to GYN-oncology who felt pregnancy-sparing debulking was not an option. The oncologist recommended termination of pregnancy due to the risks of delaying chemotherapy. JM refused, citing her fertility difficulties in the past and her desire to carry the pregnancy to term "even if it kills me." She tells the oncologist she cannot bear the thought of terminating her pregnancy under any circumstances. The oncologist wants to comply with her wishes but feels the patient is making a choice that would result in harm to herself. The oncology team requests an ethics consult.

Clinical Institute

Cancer

Clinical Institute

Women & Children

Department

Oncology

Department

Obstetrics & Gynecology

Department

Palliative Care

Link to Full Text

PSJH Full Text

Share

COinS