Introduction

Summary

The clinical care of pregnant women and children raises unique and complex ethical issues for three reasons. Firstly, unlike in other areas of medicine where the primary ethical principle is respect for patient autonomy, the care of pregnant women and children requires a balancing act. During pregnancy, the balancing act may involve the weighing of actual physical risks to the pregnant woman against potential benefits for her fetus. After the birth of the child, the balancing requires us to weigh the child's medical interests against the psychological, spiritual, or economic interests of his or her parents and family. This balancing requires that decisions reflect considerations other than the values, desires, or stated wishes of the patient. Parents, doctors, ethics committees, judges, or other adults must decide what is or is not permissible for a given child or a group of children.

Obstetrics and pediatrics are also especially complicated because the goal of clinical medicine in these areas is fundamentally different from that in other areas of medicine. In other areas, medicine works against the inevitable. Everybody will get sick. Everybody will die. In obstetrics and pediatrics, however, the hope and the goal is that everyone will be healthy. In fact, most pregnancies turn out well, most children do not get seriously ill, and very few die during childbirth or childhood. The goal in obstetrics and pediatrics is to preserve and protect good health, rather than to diagnose and cure disease. Both are, fundamentally, preventive.