The Unlimited-Rights Model of Obstetric Ethics Threatens Professionalism

Background: In the professional ethics of obstetrics, respect for autonomy supports the crucial right of women to make their own decisions about whether to accept or refuse the recommendations their obstetricians make. What we have called the professional responsibility model of obstetric ethics includes the decisional rights of patients as essential. Obstetricians should therefore respect the decisional rights of pregnant women throughout pregnancy, from prenatal diagnosis to intrapartum management. In addition, the professional responsibility model strongly advocates for the global human rights of women and children to perinatal healthcare, especially impoverished women and women in low-income countries.Material and Methods: This study is article reviewResults: In the unlimited-rights model of obstetric ethics obstetricians have an ethical obligation that demands identification of the values of patients before making any recommendation in any clinical circumstance. The unlimited-rights model makes shared decision making, in which ‘physicians must base their recommendations on the patient’s values rather than on their own,’ required for all clinical decision making with patients. Shared decision making thus understood requires the doctor to elicit the patient’s values as the basis for recommendations and therefore subsequent decision making. Beneficence-based recommendations that do not include the patient’s values are disallowed, to prevent the risk of substituting the doctor’s values for those of the patient. The unlimited-rights model and its demand for nondirective shared decision making requires the obstetrician to first take into account the patient’s values.Conclusion: The unlimited-rights model should be replaced with the clinically more nuanced and applicable professional responsibility model, in which obstetricians have professional obligations to patients and in which patients’ rights have an essential but not unlimited role.