What is the appropriate action when a pregnant woman with a fetus diagnosed with anencephaly (congenital absence of a major portion of the brain) wants to terminate the pregnancy, but her husband refuses to consent?

Only the Pregnant Woman's Consent is Required

A pregnant woman with decision-making capacity has the sole legal and ethical authority to consent to termination of pregnancy, regardless of her husband's objections—the appropriate action is to proceed with only her consent (Answer B). 1

Legal and Ethical Foundation

The fundamental principle is clear and unequivocal:

• In law, a pregnant woman with capacity can refuse any treatment for any reason, even if this puts the unborn child at risk of harm or death. 1
• This same autonomy extends to accepting treatment, including pregnancy termination
• The pregnant woman is the patient, and only she can provide consent for maternal interventions 1
• No spousal consent is required for medical procedures performed on a competent adult woman 1

Application to Anencephaly

In this specific case involving anencephaly (a lethal fetal anomaly):

• Ethical care of pregnant patients requires that maternal medical benefit take priority when maternal and fetal benefit intractably conflict 1
• The pregnant patient may exercise autonomy by choosing termination when counseled about a severe fetal anomaly 1
• Clinicians should respect pregnant individuals' autonomy to make decisions that best align with their core values after counseling that provides all medically appropriate options 1

The Role of the Husband

While involving family members in counseling is appropriate:

• The husband has no legal veto power over the woman's medical decisions 1
• Counseling may include the partner to provide support and facilitate shared understanding 1
• However, the final decision rests solely with the pregnant woman who has capacity 1

Critical Pitfalls to Avoid

Do not delay the procedure waiting for spousal consent:

• Delaying counseling or procedure can directly impact success rates and complication risks 2
• The woman's autonomous decision is sufficient to proceed 1

Do not seek court orders or representatives:

• An emergency court order would only be considered if the woman lacks decision-making capacity, not because her husband disagrees 1
• A representative is only needed when the patient is incompetent to make decisions 1

Practical Implementation

Proceed with the following steps:

1. Document the woman's capacity to make medical decisions (not compromised by severe distress, medication, or cognitive impairment) 1
2. Ensure informed consent from the woman alone, documenting her understanding of the diagnosis, prognosis, and treatment options 1, 2
3. Offer counseling support that may include the husband, but make clear that his consent is not required 1
4. Schedule the procedure based on the woman's decision, as timing matters for safety and outcomes 2, 3

The answer is (B) Only need her consent—no spousal permission, notification requirement, or representative consent is legally or ethically necessary when a competent pregnant woman makes a medical decision about her own body. 1