Jamie Abrams, ‘The Illusion of Autonomy in Women’s Medical Decision-Making’

This Article considers why there is not more conflict between women and their doctors in obstetric decision-making. While patients in every other medical context have complete autonomy to refuse treatment against medical advice, elect high-risk courses of action, and prioritize their own interests above any other decision-making metric, childbirth is viewed anomalously because of the duty to the fetus that the state and the doctor owe at birth. Many feminist scholars have analyzed the complex resolution of these conflicts when they arise, particularly when the state threatens to intervene to override the birthing woman’s autonomy. This Article instead considers the far more common scenario when women and their doctors align in the face of great decision-making complexity and uncertainty. What decision-making framework normalizes this doctor-patient alignment, and how does this decision-making framework complicate the actualization of autonomy for the women who do not elect this framework? This Article concludes that many, if not most, of the four million women who birth in hospital settings attended by physicians align with their doctors by applying a shared decision-making framework that presumptively elects the outcome that minimizes any, even minor, risks to the fetus. While individual patients can certainly elect this approach autonomously, when understood in the context of tort law — in which the actions of ‘most women’ and ‘most doctors’ can become the standard of care itself — this framework is deeply concerning …

Jamie R Abrams, The Illusion of Autonomy in Women’s Medical Decision-Making. Florida State University Law Review, Volume 42, No 1 (2014).

First posted 2015-04-09 10:22:44

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