Ethical decision-making in abortion for a perimenopausal woman with unintended pregnancy: A case report

Abstract

   Background: Abortion decision-making is ethically complex, particularly in perimenopausal women with cardiovascular comorbidities. Understanding the clinical and ethical challenges in such cases is essential for patient-centred care.
   Case presentation: We report a case of a 51-year-old perimenopausal woman with myocardial infarction-related mitral regurgitation who presented with an unintended 10-week pregnancy. She experienced significant anxiety and psychological distress due to the unexpected pregnancy and moral conflict regarding abortion. Clinical evaluation, including ultrasound, confirmed a viable foetus with normal cardiac activity. Using the four-box approach, medical indications, patient preferences, quality of life, and contextual factors were systematically assessed to support ethically sound and patient-centred decision-making.
   Conclusions: This case highlights the importance of integrating ethical frameworks into clinical care when managing complex reproductive decisions in patients with high-risk comorbidities. The structured four-box approach facilitates informed, safe, and ethically responsible care while respecting patient autonomy.

DOI: 10.59715/pntjmp.5.2.21