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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.[163]

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.

[163]ACOG: Committee Opinion 63, Sterilization of Women Who are Mentally Handicapped. (Sept 1988).



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