 Pregnant women with limited capacity for autonomous agency and decision-making (due to cognitive disability, mental illness, drug use, etc.) still have the right to have their (limited) autonomy respected and fostered to the largest extent possible; at the same time, both they and their future children must be protected somehow from harms that bad choices stemming from decisional impairment could cause. Such women are often particularly socially vulnerable and frequent targets of manipulation; they face multiple barriers to having their reproductive and sexual health needs recognized and met (e.g. see Greenwood and Wilkinson 2013 on women with intellectual disabilities). Protecting their agency and well-being as well as the well-being of their future children can thus be a delicate negotiation. Furthermore, physicians and family members may not be neutral parties when it comes to assessing a pregnant woman's level of decisional competence: if they disagree with her expressed desires concerning her own care (for example, her opposition to abortion, or refusal of medication or bed rest) or believe her choices put her fetus at unacceptable risk, they may be motivated to overestimate her level of decisional impairment, thereby justifying paternalistically overriding her expressed wishes.