Clinical guides to preventing ethical conflicts between pregnant women and their physicians

Abstract

We provide a justification for preventive ethics in obstetric practice. Four clinical guides to resolving ethical conflicts between pregnant women and their physicians can be identified: (1) informed consent as an ongoing dialogue between the pregnant woman and her physician, (2) negotiation as a clinical strategy, (3) respectful persuasion as a clinical strategy, and (4) the proper use of ethics committees.

PIP: The authors do not universally respect maternal autonomy in receiving obstetric care as an absolute ethical principle. In cases where a fetus' life may be saved through obstetric intervention, the paper provides ethical alternatives in support of avoiding and preventing patient-physician conflict over intervention in decision-making. Obstetrician-maternal dialogue may instead by proactive as both parties envision and discuss potential ethical conflicts in practice before they arise rather than waiting until a reactive approach becomes necessary. The authors identify 4 clinical guides for resolving ethical conflicts between pregnant women and their physicians including informed consent as an ongoing dialogue between both parties, negotiation as a clinical strategy, respectful persuasion as a clinical strategy, and the use of ethics committees. These proactive formats are advantageous due to their focus upon similarities and differences in values and beliefs rather than upon specific decisions, their reducing effect upon emotional stress and ethical risks, and the attention placed upon matters of significant consequence to both parties. Moreover, the need to resort to court orders should diminish with the increased possibility of detecting irreconcilable value-based differences early in the patient-physician relationship, allowing time to end in the relationship if so concluded by either or both parties.