Redefining Primum Non Nocere to Include Reproductive Autonomy: A New Paradigm in Subspecialty Medicine

Abstract

People with chronic medical illnesses are at particularly high risk for adverse pregnancy outcomes, yet current clinical approaches largely fail to identify and support their individualized reproductive and pregnancy goals. Instead, the predominant approach to pregnancy in subspecialty medicine is disease centered rather than patient centered. To better meet the individual needs and preferences of people with childbearing potential who have chronic medical conditions, we advocate in this article for a paradigm shift in subspecialty care that honors individuals' reproductive autonomy and human right of reproduction.

Engaging Stakeholders in the Development of a Reproductive Goals Decision AID for Women with Cystic Fibrosis

“…22 Our conceptual model pairs these frameworks by incorporating patient-centered approaches while providing up-to-date medical evidence to best support pwCF safely achieve the reproductive goals that are right for them and for their families. 23…”

A Framework for Femtech: Guiding Principles for Developing Digital Reproductive Health Tools in the United States

“…Obstetricians and primary care providers often lack adequate disease-related knowledge to provide family planning care that comprehensively addresses patients' information needs [59]. Furthermore, clinicians may have social biases that lead them to counsel patients about their reproductive options differently with consideration of their social and economic backgrounds in addition to their health [60].…”

A blueprint for a new model of sexual and reproductive health care in subspecialty medicine

“…Such perspectives are reflective of a person's basic human right to make reproductive decisions that are best for them, and clinicians should not consider such decision making to be an indicator of noncompliance, lack of foresight, or irresponsibility. 10 Indeed, some clinicians' negative attitudes about a person's "fitness"…”

“…For example, some people with severe illnesses will be willing to risk their lives to experience pregnancy, 64 whereas others will wish to terminate an undesired or high‐risk pregnancy. Such perspectives are reflective of a person's basic human right to make reproductive decisions that are best for them, and clinicians should not consider such decision making to be an indicator of noncompliance, lack of foresight, or irresponsibility 10 …”

“…[7][8][9] In addition, people of color, people who are poor, or who are otherwise socially marginalized, experience the worst pregnancy outcomes as a result of the complex intersections between chronic disease and social determinants of health, structural and medical racism, and inadequate access to quality health care. 10,11 Medicine subspecialists are often consulted to provide expert clinical care to people whose chronic diseases are particularly severe, complicated, or rare. 12 Subspecialists are responsible for helping to manage the pregnancies of some of the most complex and severely ill patients-the very patients who are at greatest risk of death during pregnancy.…”