What should be a healthcare provider's stance when a pregnant patient from a low socioeconomic status wants an abortion, but the provider has personal beliefs against it?

Healthcare Provider's Ethical Obligation: Non-Biased Counseling

The provider must give advice in a non-biased way (Option A), providing accurate, balanced information about all medically appropriate options while respecting the patient's autonomy to make decisions aligned with her own values—the provider's personal beliefs must not impair patient counseling or care. 1

Core Ethical Framework

The Society for Maternal-Fetal Medicine and ACOG establish clear ethical principles that govern this scenario:

• Clinicians must respect pregnant individuals' autonomy to make decisions that best align with their core values after receiving counseling that provides all medically appropriate options for informed decision-making 1

• Healthcare providers should practice active listening and self-reflection to identify any differences, ensure their biases do not cloud their ability to provide neutral counseling, and speak with a judgment-free and respectful tone and language 1, 2

• It is critical that the health care team provide accurate, balanced, and unbiased information and guidance—institutions should develop consensus guidelines to ensure that differences in providers' personal beliefs do not impair patient counseling or care 1

What the Provider Must Do

Provide Comprehensive, Non-Directive Counseling

• Present all medically appropriate options including both pregnancy continuation and termination, with information about risks, benefits, and what to expect with each option 1

• Avoid directive language that steers the patient toward the provider's personal preference—the counseling must be nondirective regarding the potential risks and benefits of pregnancy continuation versus termination 1

• Include socioeconomic considerations as legitimate factors in the patient's decision-making process, as these affect her ability to care for herself and a child 1

Address the Patient's Values, Not the Provider's

• Facilitate values-based decision making by helping the patient identify what matters most to her, rather than imposing the provider's religious or personal beliefs 1

• Use values clarification methods to help the patient think about the desirability of options within her specific context and identify which option she prefers 1

• Recognize that 87% of women seeking abortion already have high confidence in their decision before counseling—the provider's role is to support autonomous decision-making, not to change the patient's mind 1

What the Provider Must NOT Do

Never Impose Personal Beliefs

• Religious arguments (Option B) are completely inappropriate and violate the ethical obligation to provide neutral, evidence-based counseling 1

• Taking the provider's stance (Option C) directly violates the principle of respect for patient autonomy and constitutes a form of structural violence through psychological coercion 2

• Personal beliefs must be identified through self-reflection and actively prevented from clouding the ability to provide neutral counseling 1

Avoid Coercive Practices

• Persuading the patient not to terminate based on personal belief represents normalization of violence in healthcare settings, where the provider attempts to control patient behavior rather than support autonomous decision-making 2

• Counseling should avoid coercion and must be patient-centered, presenting alternatives without pressure 1

When Provider Cannot Provide Unbiased Counseling

Obligation to Refer

• If the provider cannot or will not provide standard reproductive services, referral to another healthcare practitioner or facility must be made in a timely manner 1

• In an emergency where referral might negatively affect the patient's physical or mental health, providers have an obligation to provide medically indicated and requested care regardless of moral objections 1

• Effective communication within the healthcare team should identify conflicts of conscience in advance, allowing development of strategies that recognize provider beliefs without impairing patient care 1

Supporting Informed Decision-Making

Provide Complete Information

• Discuss short-term and long-term implications of both pregnancy continuation and termination specific to her socioeconomic circumstances 1

• Include information about contraception options to prevent future unintended pregnancies, beginning this counseling during the current pregnancy 1

• Ensure the patient understands that she has the right to change her mind and should have access to timely care if she does 1

Facilitate Access to Resources

• Connect the patient to social services that can address socioeconomic barriers if she desires pregnancy continuation 1

• Provide referrals to appropriate specialists (maternal-fetal medicine, complex family planning) as quickly as possible to optimize her options 1

• Ensure counseling occurs expeditiously to optimize choices, as delays can limit available options 1

Common Pitfalls to Avoid

• Do not deflect when patients ask "What would you do?"—this can be reframed as an opportunity to elicit the patient's values rather than imposing your own 1

• Do not assume the patient needs to be "educated out of" her decision—most patients have already carefully considered their circumstances 1

• Do not allow institutional policies to be more restrictive than necessary—advocate for policies that support the full range of reproductive healthcare 1

• Do not confuse independence with autonomy—patients can make autonomous decisions while receiving your expert guidance, as long as that guidance remains unbiased 3