Assisted Decision Making Using Direct Counseling in a Pregnant Woman With Major Depressive Disorder

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To the Editor: Major depression that occurs during pregnancy affects a woman’s judgment in making decisions related to the pregnancy and the fetus, including the decision about whether to continue a pregnancy. The psychiatrist should balance respect for the autonomy of the depressed woman with beneficence-based obligations to the pregnant woman and also to the fetus, when the fetus is viable. Coverdale et al have discussed the clinical implications of respect for autonomy in the psychiatric treatment of pregnant patients with depression and have recommended strategies for assessing decision-making abilities and for enhancing their autonomy.