ETHICAL DILEMMAS IN REPRODUCTIVE CARE
Few other areas of medicine are as fraught with ethical and legal hazards as is
reproductive care. Some physicians see abortion and contraception as sins; some
find it immoral that women who are not able to support their existing children
are not prevented from having more children; most consider it unethical to deny
women medical control over their own bodies. Charting a legally and ethically
defensible path through this minefield is difficult. The fundamental principle
that must underlie all medical care is that of honesty:
- The principle of autonomy requires that a patient be given complete and
truthful information about her medical condition and any proposed treatment.
Only with such information is she able to exercise her right to make choices
about health care. If complete information is not available, existing
uncertainty should be shared with the patient. It is inappropriate for a
physician to assume that he or she is better able to assess what the patient
would want to know than is the patient herself. In general, a patient benefits
from a full understanding of her medical condition, its prognosis, and the
treatment available. The perception that a physician has concealed the truth or
has engaged in deception will weaken the patient trust and undermine the
physician-patient relationship. Thus the norm of honesty can be based on the
principle of beneficence as well as on the principle of autonomy.
Honest and ethical reproductive care should ensure (1) that patients are
given full information about any restrictions on reproductive care provided by
the physician; (2) that physicians counsel patients about alternative care even
if they do not provide the care; (3) that physicians are not bound to provide
elective care that is abhorrent to their religious beliefs; (4) that physicians
balance the medical necessity of sexual history taking with the patient's
concern for privacy; and (5) that physicians do not compromise a patient's
health by refusing to provide needed care in an emergency, even if the
physician could refuse to provide the same services on an elective basis.
ACOG: Committee Opinion 63,
Sterilization of Women Who are Mentally Handicapped. (Sept 1988).
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