Physician duty to the patient:
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1.
Preconception:
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Initiate a discussion with all patients of childbearing potential about contraception and pregnancy.
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Do not assume anticipatory motherhood (that all women would like to pursue biologic pregnancy).
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Initiate discussions around pregnancy early in the longitudinal patient relationship to optimize timing and allow for an evolving discussion over time.
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Provide patient-specific risks and benefits of pursuing pregnancy, and initiate steps that can be taken to mitigate risk if desired by the patient.
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If pregnancy is considered high risk such that pregnancy is not advisable, inform the patient, but facilitate autonomous decision-making.
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2.
During pregnancy:
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Use a shared decision-making model to allow the patient to decide on whether to pursue or terminate pregnancy.
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Regardless of the patient’s decisions surrounding their pregnancy, the physician has a duty to provide ongoing care.
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Multidisciplinary teams may be well suited to support high-risk pregnancies to optimize maternal and fetal outcomes.
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Physician duty to the fetus:
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Physician has duty to limit exposure to fetotoxic medications where possible.
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A child is not ethically wronged to be born to a patient with a shortened lifespan, although, as with all parents-to-be, the patient should consider who may step into the parent role if they were to pass away.
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Physician duty to the health-care system:
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The physician duty to their patient supersedes their duty to use resources judiciously.
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Patients who wish to pursue pregnancy, but are unable to conceive naturally, should be referred to obstetric specialists for consideration for assisted reproductive technology.
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