The situation that you describes raises all sorts of interesting philosophical questions, but since you don’t ask any, I’m not sure which to address. I'll assume for the sake of this discussion that you’re not wondering whether your patient could possibly be right about God’s intentions. So, let’s assume that she’s wrong: God won’t take care of her and her fetus, and she’s placing her future child at significant risk of harm that would permanently and seriously restrict his (let’s give him a gender for the sake of this discussion) future life opportunities. There are then two questions that you might have in mind. One: “Is she doing something that is morally wrong?” Two: “What are my own moral obligations in this situation?” The answer to neither question is straightforward.

First question: The answer to the first question is complicated by two facts– (a) the individual who would be harmed by your patient’s lack of treatment is currently a fetus, and (b) your patient is apparently ignorant of the fact that she really is putting her future child at risk of harm.

While the rights of children are fairly uncontroversial, the rights of fetuses are highly contested. However, we can avoid this controversy by talking simply about your patient’s future child. If this future child were to be mentally handicapped because she now refuses to take treatment, then she would have made him much worse off than he otherwise would have been. As a result of her action, he would have a significantly more restricted range of reasonable life plans available to him than he would otherwise have had. Her action, then, puts her future child at significant risk of significant harm. From a moral point of view, it seems to me, it is irrelevant whether one’s actions cause someone immediate harm or harm someone some time in the distant future. On these grounds alone, I would conclude that your patient’s refusal of treatment is morally wrong.

However, some might argue that we cannot say that her action is morally wrong, since she is doing what she thinks is best for her future child– she just happens to be mistaken about what is best for her future child. Only if her ignorance is itself culpable, can we charge her with immorality.

Though many philosophers would disagree with me, I would like to distinguish the conditions under which one counts as performing an action that is wrong and the conditions under which one counts as being a bad person or as doing something that is morally blameworthy. An action can be wrong, perhaps because it has terrible consequences. But the person who does the wrong action might nonetheless be a good person because through no fault of her own, she did not anticipate these bad consequences. To use a familiar example, a Good Samaritan might go to some trouble to save the life of a person who turns out to be a serial murderer. Was her action morally correct? I would want to say “no.” Had she not so acted, many valuable lives would not been shortened. No action with such bad (even if indirect) consequences could be morally right. Other philosophers would insist that what the Good Samaritan did was morally correct, since the direct result of her own action was the extending of the life of a fellow human being (who just happened to be a serial killer) and since the shortening of the lives of his victims wasn't the direct result of her own action but instead was the direct result of the serial killer's actions. Despite this disagreement about the morality of her action, all of us can agree that the Good Samaritan was a good person and that she could not be morally blamed for doing what she did.

Returning now to your patient. I would say that her action is morally wrong. Others would say that her action is morally wrong only if she is culpably ignorant of the likely harmful consequences of her action. It’s an interesting question, which I can’t answer here, whether someone who lives in the 21st century who believes that God will take care of her and her fetus is culpably ignorant and thus morally blameworthy for the consequences of actions that are based on this belief.

Second question: What are your moral obligations? On the assumption that your patient’s behavior is morally wrong, what follows? Unfortunately, not much. The fact that one person’s potential actions are immoral does not by itself imply that another person is morally permitted to prevent her from acting immorally. Physicians play an important beneficial role within our society and their ability to play that beneficial role could be jeopardized if they were to take it upon themselves (especially as a matter of professional obligation) to prevent their patients from acting immorally. Patients might refuse to get further treatment from those whom they regard as meddling doctors, and the health consequences for both patients and fetuses (and the future children they become) could be devastating.