Professional ethics in obstetrics is based on the ethical principles of beneficence, respect for autonomy, and justice and the professional virtues of integrity, humility, compassion, self-effacement, and self-sacrifice. The ethical principle of beneficence and the professional virtue of integrity are directly applicable tools for addressing the question posed in this paper.
The Coronavirus disease of 2019 (COVID-19) pandemic is unprecedented in our lifetime, especially in perinatology. In this publication, we will discuss important clinical ethical lessons we learned during the pandemic, including COVID-19 vaccination and physician hesitancy, ringfencing, and frameshifting.
The gold standard is to strongly recommend COVID-19 vaccinations to those trying to get pregnant, to those who are pregnant, and to those who are postpartum.
The three root causes of physician hesitancy—misapplication of therapeutic nihilism, misapplication of shared decision-making, and misapplication of respect for autonomy should not be ignored and need to be addressed.
It is important that we heed Brent's insightful recommendations. Doing nothing with respect to vaccination is not an option, whether it applies to COVID-19 vaccines or to future pandemics. Physician hesitation is not an option. When there is sufficient evidence of vaccine safety and effectiveness without documented risks, vaccine recommendations before, during, and after pregnancy should be explicitly made to prevent maternal, fetal, and neonatal morbidity and mortality.
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