Obstetricians' Morality and Perinatal Decision Making [2E]

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Abstract

INTRODUCTION:

Patient counseling should be based on medical facts and values. However, obstetricians' decision-making may be affected by moral values. We studied the degree to which personal morality influences counseling in obstetrics.

METHODS:

Obstetricians (n=249) completed surveys regarding management of obstetrical scenarios (eg, deference to parents' request for more or less aggressive neonate resuscitation). A validated instrument was used to determine respondents' moral priorities (autonomy, community, divinity), which were compared to clinical decisions. Respondents were asked if they'd act without consent to save a fetus/neonate if: a) a cord prolapsed and b) a newborn needed its mother's bone marrow to survive. Finally, half of respondents were told home births (the other half was told TOLAC) posed a 1 in 1000 risk of death, and were asked if 1 in 1000 was an acceptable risk. Analyses: chi square test/t test, Pearson correlation.

RESULTS:

Scoring higher on autonomy and community was associated with greater deference to parental decision-making. Without consent, 54.5% would perform a c-section, but only 26.1% would take bone marrow (P=.001). Those who prioritized divinity were more likely to perform both procedures (c-section P=.04; marrow P=.01) without consent. Given the same risk of death for either home birth or TOLAC, 71.1% considered TOLAC an acceptable risk, compared to 36.1% for home birth (P=.001).

CONCLUSION:

Moral values, rather than just facts and health values, influence counseling. To minimize “bias” when counseling patients, physicians should base counseling on health values (eg, beneficence, truth telling) rather than personal beliefs (eg, I hate big families). Awareness of personal bias is a first step.

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