The physician should learn as much as possible about social factors that affect a patient’s decisions. The patient must consider the risks of losing the baby, the risks of a damaged infant, and the risks that she is willing to assume to carry the baby. The decisions of a married woman in her thirties who has taken years to conceive are likely to be very different from the decisions of a single woman in her teens who is considering adoption. A patient who does not tell her physician about her desires and expectations should be asked about them. Most women have a personal image of childbirth that the physician must understand. The further this image is from reality, the greater is the likelihood of conflict.

The physician should work to avoid exercising undue influence on the patient’s decisions. If there are strong medical reasons for making a certain decision, the physician should make these reasons clear. The physician should realize that the social reasons may outweigh the medical reasons for a particular patient. The choices of a married male physician in his forties with six healthy children at home are not likely to match the decisions of either of our hypothetical patients.