ETHICS OF TERMINATION OF PREGNANCY (TOP) IN MYASTHENIA GRAVIS: A CASE REPORT

Abstract

Introduction: Myasthenia gravis (MG), an autoimmune disorder characterised by muscle weakness caused by impairment of the acetylcholine receptors at the neuromuscular junction as a result of autoantibodies acting against the ACh receptors, is twice as common in women, occurring in the second and third decades.  Successful pregnancy outcomes are possible with patient compliance to medication and care by a multidisciplinary team.Objective: The article demonstrates the ethical dilemma doctors face when dealing with termination of pregnancy in myasthenia gravis in pregnancy.Discussion: During pregnancy, MG exacerbates in one third of patients during the first trimester, and tends to improve during the second and third trimesters, with most women achieving normal delivery. The authors put up a case where decision for termination of pregnancy (TOP) could have been avoided through application of an ethical decision making framework.  The patient could have decided otherwise if a clear alternative line of management had been offered. Fully informed consent is essential preserving was not given and patient autonomy in such complex decisions. The emotive effects on the patient that biomedical imaging like showing a normal and active foetus through ultrasonography also needs to be considered.Analysis: A possible ethical framework using some of the principles of ethical decision-making, under the headings of i). Clear justification according to the norms and values of the individual, law and society for the intervention ii). Patient autonomy iii). Incongruence between parents in the abortion decision iv). The foetus as a person v). Directive counselling vi). Principle-based ethics, and, vii). Case-based ethics and case-based reasoning could be applied when confronted with the issue of termination of pregnancy in MG. While principle-based ethics is a useful starting point, care-based ethics also has a place in decisions on TOP.