title: Home birth: what are physicians' ethical obligations when patient choices may carry increased risk?
abstract: 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.
authors.affiliation: 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.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Ecker
authors.forename: Howard
authors.initials: H
authors.lastname: Minkoff
mesh_terms: D004992:Ethics, Medical; D005260:Female; D006700:Home Childbirth / Q000941:ethics*; D006801:Humans; D010342:Patient Acceptance of Health Care; D026684:Personal Autonomy; D010817:Physician-Patient Relations; D011247:Pregnancy; D012306:Risk