Clinical opinion
Obstetrics
The professional responsibility model of obstetrical ethics: avoiding the perils of clashing rights

https://doi.org/10.1016/j.ajog.2011.06.006Get rights and content

Obstetric ethics is sometimes represented by polarized views. One extreme asserts the rights of the fetus as the overwhelming ethical consideration. Another extreme asserts the pregnant woman as the overwhelming ethical consideration. Both assertions are overly simplistic. Such oversimplification is called reductionism. This article explains the fallacy of rights-based reductionism and 2 models of obstetric ethics based on it and explains why the fetal rights reductionism model and the pregnant woman's rights reductionism model result in conceptual and clinical failure and therefore should be abandoned. The article argues for the professional responsibility model of obstetric ethics, which emphasizes the importance of medical science and compassionate clinical care of both the pregnant and fetal patient. The result is that responsible medical care overrides the extremes of clashing rights.

Section snippets

Fallacy of rights-based reductionism

The fallacy of rights-based reductionism can be understood by analogy to the fallacy of biologic reductionism or oversimplification of scientific models of disease and health. As an antidote to biologic reductionism in medicine, George Engel made a sentinel contribution with his introduction of the biopsychosocial concept of health and disease.6, 7, 8, 9 In his classic paper in Science, Engel summarized the biomedical model:

The dominant model of disease is biomedical, with molecular biology

Professional responsibility model of obstetrics ethics

Because they are fallacious, rights-based reductionism models distort the fundamental nature of the relationship of a physician to his or her patients, a relationship of professional ethical obligations (Table). The professional obligations of the obstetrician-gynecologist originate in the ethical concept of medicine as a profession. This concept was introduced into the history of medicine by 2 remarkable British physician-ethicists: John Gregory (1724-1773) of Scotland and Thomas Percival

Conclusion

The Scylla and Charybdis of rights-based reductionism models should be abandoned and replaced by the professional responsibility model. By basing obstetric practice on the professional responsibility model of obstetric ethics, the obstetrician creates a solid foundation for the care of the pregnant and fetal patient: the physician-patient relationship as a professional commitment.

References (32)

  • G. Engel

    The clinical application of the biopsychosocial model

    Am J Psychiatry

    (1980)
  • G. Engel

    The biopsychosocial model and medical education

    New Engl J Med

    (1982)
  • R. Fan

    The discourses of Confucian medical ethics

  • R. Porter

    The greatest benefit to mankind: a medical history of humanity

    (1998)
  • A. Zucker

    Moral monads and ethical reductionism

    J Religious Ethics

    (1984)
  • L.S.M. Johnson

    Abortion: II, contemporary ethical and legal aspects: A. ethical perspectives

  • Cited by (92)

    • Professionally Responsible Counseling About Fetal Analysis

      2021, Obstetrics and Gynecology Clinics of North America
    View all citing articles on Scopus

    The authors report no conflict of interest.

    Reprints not available from the authors.

    Cite this article as: Chervenak F, McCullough LB, Brent RL. The professional responsibility model of obstetrical ethics: avoiding the perils of clashing rights. Am J Obstet Gynecol 2011;205:315.e1-5.

    View full text