How Do I Discuss This with My Daughter?

Healthcare providers are bound by medical ethics to guide the care that they deliver. The underlying ethical principles in medicine are (1) beneficence or “to do good”, (2) non-maleficence or “do no harm”, (3) autonomy or respect for the self-determination of the patient, and (4) justice or equitable distribution of care to patients. Each healthcare encounter that we are involved with is governed by these principles in some way or another.

When the supreme court of the United States eliminated the constitutional right to a medical procedure for women by overturning Roe vs Wade, on June 24th, 2022, I was speechless. The right to an abortion and a women’s right to choose are bound and supported within the framework of basic medical ethics. While all the ethical principles have equal importance, the principle that resonates in this particular ruling is autonomy.

Autonomy has always been a part of medical care in the US, but the culture of medicine was previously more paternalistic in nature like that of a parent/child relationship. Paternalism propagates the idea that medical care is dictated by the medical team without full consideration for the autonomy of the individual who requires the medical care. Paternalism doesn’t fully disregard the autonomy of a patient’s right to self-determination, but it basically says that “we know more than you and you need to listen to us.” The physician tells the patient what to do and the patient obeys.

In the current era of medicine, the care model has shifted more away from the paternalistic culture and more toward patient autonomy and patient-centered care models. With a more patient-centered and autonomy-focused model, the physician and the patient make a shared decision about a medical plan and the patient’s opinions and desires are weighted more in the final decision. We respect the decisions of mentally competent patients or surrogate caregivers to make the right medical decisions for the interested party.

Autonomy is not only a governing principle in medical ethics but also a governing principle of the foundation of personhood in life. At this point, it is important to quote Justice Ruth Bader Ginsberg. She said, “The decision whether or not to bear a child is central to a woman’s life, to her well-being and dignity. It is a decision she must make for herself. When the government controls that decision for her, she is being treated as less than a full adult human responsible for her own choices.” To not allow competent individuals to make their own decisions in their medical care or life is to take away a piece of their humanity. This is a good example of why, in medicine, autonomy is a coveted principle in medical ethics and, additionally, in life.

With the supreme court decision this week, it saddens me to know that half of the population of the US has had their autonomy diminished. I have a daughter. She is faced with the knowledge that her rights have been affected because of her gender. While one could argue that the ruling was not intended to discriminate against women, one would overlook the fact that only women can become pregnant at this time (for those who are able to get pregnant). So, how could one not conclude that this decision that affects the right to self-determination is not gender-based bias?

Because one cannot ignore the gender-based bias, the supreme court decision leaves me with more questions. As a person in our society, how can I justify the supreme court’s decision in this day and age? As a physician, how can I explain that half of the population has just lost autonomy over their own medical decision-making? As a father, how do I discuss all of this with my daughter?