# Situation: A nurse works in the delivery room of a provincial hospital that is a comprehensive emergency obstetric and newborn care (CEmONC) referral facility. A 16-year-old unmarried primigravida at 38 weeks' gestation is brought in unconscious after a seizure by her 20-year-old boyfriend. Her parents and other relatives cannot be reached despite repeated calls, and the obstetrician decides that an emergency cesarean birth is needed at once to save her and the baby. On what basis may the team proceed?

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> subject: Nursing Practice II — Maternal and Child Health Nursing

## 문제

Situation: A nurse works in the delivery room of a provincial hospital that is a comprehensive emergency obstetric and newborn care (CEmONC) referral facility.

A 16-year-old unmarried primigravida at 38 weeks' gestation is brought in unconscious after a seizure by her 20-year-old boyfriend. Her parents and other relatives cannot be reached despite repeated calls, and the obstetrician decides that an emergency cesarean birth is needed at once to save her and the baby. On what basis may the team proceed?

## 보기

1. Implied consent in a life-threatening emergency **✔ 정답**
2. An order from a court, because she is a minor
3. Her remark at a prenatal visit to 'do what is needed'
4. The boyfriend's written consent as the father of her baby

**정답: 1**

## 해설

A minor's consent to surgery normally comes from a parent or legal guardian, and an unmarried boyfriend is neither. When no authorized surrogate can be reached and delay would threaten life, consent is implied and life-saving treatment may proceed. The team documents the emergency, her condition, and every attempt to reach her parents.

## 심화 해설

The situation raises a core question in emergency obstetric care: when a pregnant adolescent is unconscious, no parent or legal guardian is reachable, and delay would endanger both the mother and fetus, what authorizes the surgical team to proceed?

Why parental consent is normally required

A minor generally cannot give legally valid consent for surgery. The authority belongs to a parent or legal guardian. In this case, the patient is 16 years old and unmarried. Her 20-year-old boyfriend is not her spouse, not her legal guardian, and has no recognized legal standing to consent on her behalf. His signature would not satisfy the consent requirement, regardless of his relationship to the fetus.

Why implied consent applies here

When a patient cannot participate in decision making and no authorized surrogate is available, the ethical and legal framework shifts. In a life-threatening emergency, consent is implied when immediate intervention is necessary to prevent death or serious harm and no authorized decision maker can be reached in time. The obstetrician has determined that emergency cesarean birth is needed at once to save both the mother and the baby. Repeated calls to the parents and relatives have failed. Under these conditions, proceeding is ethically justified by the principles of beneficence (acting to preserve life) and nonmaleficence (avoiding preventable harm from delay).

The 2025 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care describe principlism as the predominant ethical framework in emergency care. It balances four principles: beneficence, nonmaleficence, respect for autonomy, and justice. When a patient cannot exercise autonomy, the other principles guide the team. In this case, respect for autonomy cannot be honored directly because the patient is unconscious and her surrogate is unreachable. The duty to preserve life therefore takes priority, and proceeding with emergency cesarean birth is consistent with the ethical framework [1].

Why the other options are incorrect

| Option | Reason it is not the basis for proceeding |
| --- | --- |
| 2. Court order because she is a minor | A court order is not required in a true emergency when delay would threaten life. Seeking one would waste critical time. Emergency exception to consent applies regardless of age. |
| 3. Her prenatal remark to “do what is needed” | A general statement made during a prenatal visit does not constitute informed consent for a specific surgical procedure. It lacks the elements of informed consent: disclosure, understanding, voluntariness, and specific authorization. |
| 4. Boyfriend’s written consent | An unmarried boyfriend has no legal authority to consent for a minor. He is not a parent, legal guardian, or spouse. His signature carries no legal weight. |

Clinical context: eclampsia and emergency cesarean

The presentation of a seizure in a primigravida at 38 weeks strongly suggests eclampsia. A case report of severe antepartum eclampsia in a 17-year-old primigravida at 35 weeks describes generalized tonic-clonic seizures, oxygen saturation of 78%, blood glucose of 47 mg/dL, and elevated blood pressure of 140/90 mmHg . This illustrates how rapidly maternal and fetal status can deteriorate. In such a scenario, delay to obtain consent from an unreachable parent directly increases the risk of maternal death, fetal demise, and multiorgan dysfunction.

Another report highlights that seizures in late pregnancy are initially presumed to be eclampsia, but persistent neurological deterioration despite obstetric management should prompt evaluation for alternative intracranial pathology such as cerebral arteriovenous malformation (AVM) . While this does not change the consent decision in the acute emergency, it is a useful clinical reminder for the post-cesarean phase: the team should remain alert for causes beyond eclampsia if the patient’s neurological status does not improve as expected.

Documentation and nursing responsibilities

Key point! The team must document the emergency nature of the situation, the patient’s unconscious state, the obstetrician’s determination that immediate cesarean birth is necessary, and every attempt made to contact the parents or other relatives. This documentation protects the team legally and demonstrates that the decision to proceed was based on the emergency exception to consent.

Watch out! Do not confuse implied consent with presumed consent. Implied consent applies only when immediate action is needed to prevent death or serious harm and no authorized surrogate is available. It does not authorize procedures that can safely wait for consent.

The emergency exception to consent is grounded in the ethical duty to preserve life when a patient cannot speak for herself and no surrogate can be reached. In this case, proceeding with emergency cesarean birth is justified by implied consent, not by the boyfriend’s signature, a court order, or a vague prenatal remark.References (research sources)

- [1]Part 3: Ethics: 2025 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.GuidelineElmer J, Atkins DL, Daya MR, Del Rios M, Fry JT, Henderson CM, Lewis-Newby M, Madrigal VN, Marco CA, Ornato JP, Paquette ET, Parnia S, Rodriguez AJ, Shapiro JP, Schexnayder SM, Weiss EM, Zientek DM, Idris AH. (2025) · DOI: 10.1161/cir.0000000000001371

## 임상 시나리오

Emergency Consent for an Unconscious MinorWhen no surrogate is reachable and delay threatens life
For a minor, surgical consent normally requires a parent or legal guardian. An unmarried boyfriend is neither a spouse nor a guardian and has no legal standing to consent.

When the patient is unconscious, no authorized surrogate can be reached, and delay would threaten life, consent is implied. The team may proceed with emergency cesarean birth based on beneficence and nonmaleficence.

CautionDocument the emergency, the patient's condition, and every attempt to reach parents or relatives before proceeding.

## 핵심 개념

- **Implied consent** — Legal/ethical principle allowing treatment without explicit consent when a patient cannot decide, no authorized surrogate is reachable, and delay would threaten life or cause serious harm.
- **CEmONC** — Comprehensive Emergency Obstetric and Newborn Care; a referral facility equipped to manage life-threatening obstetric and neonatal emergencies.
- **Primigravida** — A woman who is pregnant for the first time.
- **Legal guardian** — A person with court-appointed or legally recognized authority to make decisions for a minor or incapacitated person.
- **Beneficence** — Ethical principle of acting in the patient's best interest to promote well-being and preserve life.

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