ACOG grounds one of its firmest rules on a blunt admission: doctors cannot reliably predict what will happen to you.
When ACOG explains why a doctor may never pressure a patient into a decision, it gives two reasons. The first is respect for the patient. The second is more interesting, and it is the one this part of the guide is built on.
ACOG writes: The use of coercion is not only ethically impermissible but also medically inadvisable because of the realities of prognostic uncertainty and the limitations of medical knowledge.
Prognostic uncertainty means not knowing what is going to happen. ACOG is saying that obstetric prediction is not good enough to justify overriding what a patient wants. That is a remarkable admission for a professional body to publish, and it cuts both ways. If prediction is not good enough to override you, it is not good enough to promise you anything either.
ACOG goes further in its consent document. When a treatment is new or the evidence is thin, the consent conversation should include potential risks yet to be quantified. In other words, not knowing is itself something you are entitled to be told. Silence is not the honest response to uncertainty. Saying so is.
How this quietly goes wrongNobody sits down and decides to tell women less. The ethics literature has a name for how it actually happens. Writing about the ways a profession's own convenience can reshape what patients hear, Chervenak, McCullough and Hale describe the need to prevent incremental drift toward dominance of guild self-interests over professionalism.
Drift, not decision. A practice that teaches women to expect less will, over time, have to deliver less, and no one will ever have chosen that. This is why the guardrail has to be written down rather than assumed.
Say this out loud"How confident are you in that prediction, and what would change it?"
"What do you not know yet about my situation?"
Where this comes from:
419. Informed consent and shared decision making in obstetrics and gynecology. ACOG Committee Opinion No. 819. American College of Obstetricians and Gynecologists. Obstet Gynecol. 2021;137(2):e34-e41.
453. Refusal of medically recommended treatment during pregnancy. ACOG Committee Opinion No. 664. American College of Obstetricians and Gynecologists. Obstet Gynecol. 2016;127(6):e175-e182. Reaffirmed 2019.
463. Chervenak FA, McCullough LB, Hale RW. Guild interests: an insidious threat to professionalism in obstetrics and gynecology. Am J Obstet Gynecol. 2018;219(6):581-584.
Covered in the essential classes
Continue
More from Two kinds of expectation
This page is educational. It supports the conversation with your own clinicians. It is not consent to any treatment, and it cannot assess you. If you are worried about a symptom now, see urgent warning signs.
