Few other areas of medicine are as fraught with ethical and legal hazards as is
reproductive care. Some medical care practitioners 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 medical care. If complete information is not
available, existing uncertainty should be shared with the patient. It is
inappropriate for a medical care practitioner 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 medical care practitioner has concealed the truth or
has engaged in deception will weaken the patient trust and undermine
the medical care practitioner–patient relationship. Thus the norm of
honesty can be based on the principle of beneficence as well as on the
principle of autonomy. [ACOG Committee Opinion 63,
Sterilization of
Women Who Are Mentally Handicapped. September 1988.]
Honest and ethical reproductive care should ensure (1) that patients are given
full information about any restrictions on reproductive care provided by the
medical care practitioner; (2) that medical care practitioners counsel patients
about alternative care even if they do not provide the care; (3) that medical
care practitioners are not bound to provide elective care that is abhorrent to
their religious beliefs; (4) that medical care practitioners balance the medical
necessity of sexual history taking with the patient’s concern for privacy; and
(5) that medical care practitioners do not compromise a patient’s health by
refusing to provide needed care in an emergency, even if the medical care
practitioner could refuse to provide the same services on an elective basis.
