In medicine, it is the physician’s obligation to promote and protect the patient’s interest. In obstetrics, the ethical principles of beneficence and autonomy provide the fundamental framework which guides the management of all pregnant patients. As there is the need for consideration of the fetus, autonomy can become a complex issue giving rise to what is sometimes called “maternal-fetal conflict.” In this paper, we aim to discuss some scenarios we encounter in our day-to-day obstetric practice such as pre-eclampsia, fetal growth restriction and labour induction when the best interests of the mother and fetus may be conflicted. We hope to illustrate that logical consideration for maternal and fetal best interests is only possible when there is adequate knowledge to support clinical practice. Certainly, with the rapid availability of newer knowledge and technology, it is the duty of the physician to be educated continuously so as to protect the patient from harm.
When we discuss maternal and fetal best interests in an ethical context, we have to deliberate on the morality of healthcare, including the morality of physicians, patients and the institutions that organise, deliver, pay for and make policies. It is the intention of this article to confine our discussion closely to the context of day-to-day obstetric practice. These discussions mostly concern beneficence and autonomy, 2 of the 4 principles in the common ethical framework.
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