Doctors’ Advice On Drinking During Pregnancy Paternalistic And Ethically Dubious

Doctors’ advice on drinking during pregnancy, including that of the Chief Medical Officer for England and the BMA, is paternalistic and ethically dubious, claims a medico-legal expert in the Journal of Medical Ethics.

Colin Gavaghan, of the School of Law at the University of Glasgow, says that, unlike heavy drinking, the evidence for a link between moderate to light drinking, and harm to the developing fetus, is far from clear-cut.

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In 2007, the UK government changed its advice, despite the lack of new evidence, and recommended total abstinence during pregnancy, closely followed by similar advice from the BMA.

However, a year later, the National Institute for Health and Clinical Excellence (NICE), said that there was no evidence of harm, provided women drank no more than one or two units a week, and research from the University of London seems to back up this approach.

This research even found that the children of mothers who drank lightly during pregnancy had fewer behavioural or developmental problems than those whose mothers abstained completely.

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Dr Gavaghan argues that while doctors may feel it best to advise abstinence in the face of uncertainty, this simply won’t do, for several reasons.

He points out that healthcare has shifted from paternalism to choice and autonomy, an essential part of which is providing information to enable patients to make informed choices.

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Where the evidence is unclear, doctors should communicate that, rather than take the easy option and duck out of trying to explain it, he contends. “It is not reasonable to replace more accurate information with less accurate merely because it is simpler to communicate,” he says.

“The days where doctors routinely withheld information... on the grounds that patients would become confused and make bad decisions are, supposedly, consigned to history,” he writes. “It is far from clear why a paternalistic exception is permitted in the case of pregnant women.”

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The other issue is that one or two drinks a week may be enjoyable for a pregnant woman and help her to relax, at a stressful time when she is besieged by demands to modify her behaviour, he says.

“For an increasing number of people, however, it seems as though the quality of life of the pregnant woman is so far behind the interests of the future child in any scale of ethical relevance as to be beneath consideration altogether,” he writes.

Given that the advice to refrain from drinking is also applied to women trying to get pregnant, abstinence could last some time, he says.

“It may be thought that, at the very least, we should require some reasonably compelling ethical justification for what is, on the face of it, a straightforward sexist policy. To date, the evidence suggests that we have no such justification,” he says.

And taking such an approach may also backfire, in the long run, he suggests. “If [doctors] are seen to be exaggerating risks that recent studies have shown to be negligible, their advice on genuine risks will carry less authority.”

Source-BMJ
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