Ethics for the labor and delivery unit

The labor and delivery unit poses unique challenges for the clinician faced with an ethical dilemma. Ethics training for physicians is heterogeneous and may not include specifics that are relevant to the obstetric anesthesiologist such as the implications of caring for a maternal-fetal dyad.

Rapid changes to the reproductive healthcare landscape have impacted healthcare professionals in recent years, who are at risk for moral distress when faced with ethical dilemmas in clinical care.

Principlism is the most commonly applied ethical theory in clinical medicine. The four principles are autonomy, beneficence, nonmaleficence, and justice. These principles are prima facie in that no one is defined as being consistently more important than another; it is the clinical situation that determines how to prioritize the principles. This framework allows the obstetric anesthesiologist to assess and manage each of these principles to provide ethically appropriate care for their patient. The aim of this article is to provide the obstetric anesthesiologist with an understanding of the foundational ethical principles that impact the ability to fulfill their fiduciary duty to advocate for patients by offering, and with informed consent, providing indicated and appropriate interventions.