 Douglas Diekema (2003) points out that decisional capacity is not a threshold capacity, and that it may fluctuate with timing, context, and type of decision. Hence, in settling on how much paternalism is appropriate in managing a decisionally impaired patient, doctors have a responsibility to try to find a time and approach that will promote and assist rather than foreclose the possibility of the patient's meaningful autonomous participation in medical decision making. Facilitating patients' autonomy in reproductive decision-making while protecting their best interests is perhaps especially challenging in cases where mood or personality disorders may erratically influence decision-making capacity (e.g. Zalpuri et al. 2015). Coverdale et al. (2004) argue that respecting the autonomy of decisionally compromised patients involves actively working towards removing or diminishing circumstantial and reversible barriers to participation in decision-making. This might include education, creative forms of involvement in decision-making from loved ones, postponing a medical decision until after psychotropic medication has had time to become effective, accommodating a patient's special needs for an environment conducive to making a decision, etc. The presence of a fetus should not serve as ground for detracting from our duty to protect a pregnant woman's right to participate in decisions about her own care to whatever extent she is capable (which is not to say that paternalistic interventions on behalf of her or her fetus's welfare are never appropriate for decisionally impaired women).