Pregnancy brings joy and excitement to some women, but great distress to those who suffer from severe mental illnesses like schizophrenia. Women with severe mental illnesses (SMIs) may have difficulty planning a pregnancy and deciding whether to continue to viability, and thence to term. Dilemmas also surround pharmacotherapy for this population, as (non)treatment is associated with its own challenges. The psychiatrist may have to make challenging decisions based on the principles of autonomy, beneficence, and relational ethics. Furthermore, there are ethical controversies inherent to the underlying pathologies, their non-treatment, and the various psychosocial factors that could impact parenting in such mothers. In addition, limited or ineffective use of family planning, mental health services, and contraception often act as forerunners of these problems. Considering the sparse literature on this topic and the perplexing legal responsibilities pertaining to the recently implemented Mental Health Care Act, 2017, we have attempted to highlight the various ethical dilemmas that confront a psychiatrist while managing a patient from this group. Keywords: pregnancy, perinatal, severe mental illness, schizophrenia, psychosis, ethics