Is it morally licit to prematurely induce labor in a woman with severe Marfan Syndrome?

We share the discussion carried out by the Clinical Ethics Committee of a University Hospital on a retrospective case of a pregnant woman with severe Marfan Syndrome. Some medical data about Marfan disease and pregnancy are: (1) pregnancy increases the risk of aortic dissection, reducing life expectancy, and (2) the most important non-obstetric causes of maternal death are due to rupture and dissection of aortic aneurysm. The patient’s clinical history includes two aneurysm repairs, one surgical and one endovascular. In addition, more recently, the patient suffered an aortic dissection requiring surgical resection with replacement. She is contraindicated for pregnancy, but a routine evaluation shows that she is pregnant with a fetus at 14 weeks gestation. She passed away suddenly. We present the case in view of similar future cases, considering what might be ethically acceptable if the patient were alive in this complex clinical situation. The seriousness of the case raises the morality of early induction of labor of a non-viable fetus. The objective is to save both lives, trying to ensure that the fetus reaches viability. However, is that goal possible? Whether the mother will die before the viability of the fetus, induction of labor could be considered an action of extreme safeguarding of the mother’s life. This is a situation where the only possibility left is to save the only life possible (the mother´s), without a physician´s choice between two lives. The final resolution requires the prudence of the physician.