CLINICAL CASE FOR DISCUSSION
Maxine Carter
Lawrence P. Ulrich, Ph.D.
Lawrence.Ulrich@notes.udayton.edu



Some Issues Raised:

Maxine Carter is 32 years old and is pregnant for her third time. The first pregnancy ended in a miscarriage after two months. She had difficulty conceiving for 3 years but her second pregnancy ended with a live birth and her son is now 7 months old. She is now 17 weeks into her third pregnancy. At 14 weeks she developed a kidney stone and the ultrasound to discover the kidney stone also revealed that her fetus has an abnormally large bladder which indicates a blockage in her urinary tract. If the blockage is not corrected the fetus could die or be profoundly retarded at birth. Ms. Carter's obstetrician initially recommended fetal surgery to place a shunt in the fetus. Ms. Carter agreed to the surgery but further tests have revealed that the sodium level in the amniotic fluid are 160 when they should be 80. Repeat tests two days later revealed a drop of only 10 points in the sodium level. The obstetrician has withdrawn the suggestion for fetal surgery stating that the continued high sodium levels have severely damaged the fetus and that the fetus is essentially dying. Ms. Carter is trying to decide whether to allow the fetus to die and have a "natural" miscarriage or to have an abortion. If the fetus dies in her uterus she could become toxic and jeopardize her possibility of becoming pregnant in the future. She and her husband want a second child very much.


1. How could natural law ethics help to resolve this case?
2. How could the principle of double effect contribute to the resolution of this case?
3. How should the utilities be weighed in this case?
4. In what way are the utilities in this case "incommensurable?"
5.  How might virtue ethics help in the resolution of this case?
6. How might feminist ethics help in the resolution of this case?
7. Do you think virtue ethics or feminist ethics makes resolving this case easier than having recourse to applying the principles of bioethics?
8. What guidance does Roe v. Wade provide for the resolution of this case?
9. What strategies would you implement to bring this case to a resolution which maximizes the well-being of the patient?
10. Who is the patient in this case?