Why this part of the guide exists, and what to say
Preventive ethics means seeing a conflict coming and heading it off. Mismatched expectations are the conflict this guide is trying to head off.
Obstetric ethics has a name for doing this work in advance rather than sorting out the wreckage afterwards. It is called preventive ethics, and it was set out for obstetric practice in 1990.
The definition, in its authors' own words: We will emphasize a preventive ethics approach, which is based on the recognition of the potential for ethical conflict in patient care and adopts ethically justified strategies to prevent those conflicts from occurring. The goal of preventive ethics is to sustain a strong obstetrician-patient relationship.
Its main instrument was named in the original 1990 paper as the first of four clinical guides: informed consent as an ongoing dialogue between the pregnant woman and her physician
. Ongoing. Not a form, not a signature, not one conversation at 12 weeks.
Here is my own reasoning from that framework, and I mark it as mine rather than as something those authors wrote. A woman who arrives at a birth, or at six weeks after one, expecting something that was never going to happen is in exactly the situation preventive ethics exists to forestall. The conflict was foreseeable at every visit. Nobody had it out loud. That makes mismatched expectations the textbook preventable conflict, and it makes this part of the guide an ethics intervention rather than a mood-management exercise.
3 commitments: to scientific and clinical competence; to the protection and promotion of the patient's health-related interests; and to keeping individual and group self-interest systematically secondary.
Teaching women to expect less so that a service has to deliver less inverts that third commitment. I am not accusing anyone of doing it deliberately. That is the point of the word drift.
Continue to share your concerns until you are heard, and your questions are answered.Its director of reproductive health at the time put it plainly:
Listening and taking seriously the concerns of pregnant and postpartum women is a simple, yet powerful action that can save lives. Women know their bodies and can often tell when something is not right.
For transparency: CDC states that the campaign is supported through a partnership with the CDC Foundation and by funding from Merck, known as MSD outside the United States and Canada, through its Merck for Mothers program. That does not weaken the sentence. You should know who paid for it.
"If I say no to this, what happens next?"
"I know it might be normal. Please write it down anyway."
"I am going to keep asking about this until someone explains it to me."