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Attitude of Health Personnel; Decision Making, ethics; Directive Counseling; Down Syndrome, diagnosis; Ethics, Medical; Female; Humans; Interviews as Topic; Midwifery; Obstetrics, ethics; Personal Autonomy; Physician-Patient Relations, ethics; Physicians; Pregnancy; Prenatal Diagnosis, ethics; Social Responsibility; Surveys and Questionnaires; Switzerland
Abstract
Routine prenatal screening for Down syndrome challenges professional non-directiveness and patient autonomy in daily clinical practices. This paper aims to describe how professionals negotiate their role when a pregnant woman asks them to become involved in the decision-making process implied by screening.; Forty-one semi-structured interviews were conducted with gynaecologists-obstetricians (n=26) and midwives (n=15) in a large Swiss city.; Three professional profiles were constructed along a continuum that defines the relative distance or proximity towards patients' demands for professional involvement in the decision-making process. The first profile insists on enforcing patient responsibility, wherein the healthcare provider avoids any form of professional participation. A second profile defends the idea of a shared decision making between patients and professionals. The third highlights the intervening factors that justify professionals' involvement in decisions.; These results illustrate various applications of the principle of autonomy and highlight the complexity of the doctor-patient relationship amidst medical decisions today.
