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Home Birth: What Are Physicians' Ethical Obligations When Patient Choices May Carry Increased Risk?

Ecker, Jeffrey MD; Minkoff, Howard MD

doi: 10.1097/AOG.0b013e3182167413
Current Commentary

Patient choices and plans may sometimes carry increased risk or include alternatives that individual physicians feel uncomfortable supporting or recommending. We consider in this commentary how the ethical principles of respect for autonomy and nonmaleficence can be balanced using, among other examples, the choice by some for a home birth. We discuss how absolute rather than relative risk should guide individuals' evaluation of patient choices, and how in some circumstances the value and safety added by a physician's participation may outweigh a potentially small increment in absolute risk that a particular patient choice carries.

Ethical arguments support obstetricians' involvement in patient choices or plans that may carry increased risk, including home birth.

From the Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; and the Department of Obstetrics and Gynecology, Maimonides Medical Center and SUNY Downstate Medical Center, New York, New York.

See related articles on pages 1183 and 1188.

Corresponding author: Jeffrey Ecker, Founders 420, Massachusetts General Hospital, 33 Fruit Street, Boston, MA 02114; e-mail:

Financial Disclosure The authors did not report any potential conflicts of interest.

© 2011 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.