'Doctor, what would you do in my position?' Health professionals and the decision-making process in pregnancy monitoring

J Med Ethics. 2014 May;40(5):310-4. doi: 10.1136/medethics-2012-100887. Epub 2013 Mar 29.


Objective: Routine prenatal screening for Down syndrome challenges professional non-directiveness and patient autonomy in daily clinical practices. This paper aims to describe how professionals negotiate their role when a pregnant woman asks them to become involved in the decision-making process implied by screening.

Methods: Forty-one semi-structured interviews were conducted with gynaecologists-obstetricians (n=26) and midwives (n=15) in a large Swiss city.

Results: Three professional profiles were constructed along a continuum that defines the relative distance or proximity towards patients' demands for professional involvement in the decision-making process. The first profile insists on enforcing patient responsibility, wherein the healthcare provider avoids any form of professional participation. A second profile defends the idea of a shared decision making between patients and professionals. The third highlights the intervening factors that justify professionals' involvement in decisions.

Conclusions: These results illustrate various applications of the principle of autonomy and highlight the complexity of the doctor-patient relationship amidst medical decisions today.

Keywords: Autonomy; Genetic Counselling/Prenatal Diagnosis; Sociology.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Attitude of Health Personnel*
  • Decision Making / ethics*
  • Directive Counseling
  • Down Syndrome / diagnosis*
  • Ethics, Medical
  • Female
  • Humans
  • Interviews as Topic
  • Midwifery
  • Obstetrics / ethics*
  • Personal Autonomy*
  • Physician-Patient Relations / ethics*
  • Physicians
  • Pregnancy
  • Prenatal Diagnosis / ethics
  • Social Responsibility
  • Surveys and Questionnaires
  • Switzerland