title: Moral science: ethical argument and the production of knowledge about place of birth.
abstract: Ethical arguments about caregiver responsibility and the limits of client autonomy rely on best evidence about the risks and benefits of medical interventions. But when the evidence is unclear, or when the peer-reviewed literature presents conflicting accounts of the evidence, how are clinicians and their clients to recommend or decide the best course of action? Conflicting evidence about the outcomes of home and hospital birth in the peer-reviewed literature offers an opportunity to explore this question. We present the contrary evidence and describe the social and cultural elements that influence the production of the science of birth, including professional, publication, and critical bias. We then consider how the science of birth has been used an misused in making ethical arguments about preferred place of birth. We conclude with a number of recommendations about the responsible use of the evidence, arguing for an "ethics of information" that can be drawn on to guide caregivers and clients in the use of evidence for clinical decision making.
authors.affiliation: Department of Medical Education and Co-Director of the Center for Bioethics and Social Sciences in Medicine, University of Michigan Medical School, in East Lansing, USA. rdevries@umich.edu
authors.forename: Raymond G
authors.initials: RG
authors.lastname: de Vries
authors.forename: Yasaswi
authors.initials: Y
authors.lastname: Paruchuri
authors.forename: Kathleen
authors.initials: K
authors.lastname: Lorenz
authors.forename: Saraswathi
authors.initials: S
authors.lastname: Vedam
mesh_terms: D003657:Decision Making / Q000941:ethics*; D036861:Delivery, Obstetric / Q000009:adverse effects / Q000941:ethics; D026689:Ethical Analysis; D019317:Evidence-Based Medicine; D005260:Female; D006282:Health Personnel / Q000941:ethics*; D006700:Home Childbirth / Q000009:adverse effects / Q000941:ethics; D006761:Hospitals; D006801:Humans; D009014:Morals; D009321:Natural Childbirth / Q000009:adverse effects / Q000941:ethics; D026684:Personal Autonomy; D011247:Pregnancy; D011256:Pregnancy Outcome; D037841:Pregnant People; D017594:Publication Bias; D012107:Research Design; D058028:Research Report / Q000592:standards; D012306:Risk