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Promoting Ethical Caregiving

"At a time when substance use disorder patients face stigma, rampant discrimination, and potential loss of custody, housing, and employment that threatens their recovery if confidentiality is breached, we must champion their rights."

Marilyn Heine, MD

AMA Women Physicians Section

"Shared decision making is a patient-centered, individualized approach to the informed consent process that involves discussion of the benefits and risks of available treatment options in the context of a patient's values and priorities."

"Confidentiality and trust are at the core of the patient–practitioner relationship. Policies and practices that criminalize individuals during pregnancy and the postpartum period create fear of punishment that compromises this relationship and prevents many pregnant people from seeking vital health services.

Criminalization of pregnant people violates the pillars of medical ethics including patient autonomy, justice, beneficence, and non-maleficence."

The practice of obstetrics and gynecology presents ethical considerations that are both universal to medicine and unique to perinatal care.

PRICIPLED PROVIDERS subscribe to beliefs that promote ethical caregiving and adopt attitudes and behaviors that protect the parent-infant dyad.



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We believe that you are the expert on your body and your health. We commit to providing you with care that respects your right to self-determination. We acknowledge that there are barriers to accessing quality healthcare and that the medical environment is potentially traumatic. So we will do our best to reduce the imbalance of power that can exist between patients and providers.


We believe that it is our responsibility to help you assess your medical needs and create a care plan to meet those needs. We care about your wellbeing. So we will work with you to identify your unique risk factors and mitigate their negative consequences. We will help you to be as healthy as you can be, even when your choices are different from what other people think you should choose.


We promote evidence-based medical care. We will give you as much information and guidance as you need to make informed decisions about your health care. We will never force or coerce you. We will work with you as you explore all your options, and together we will arrive at solutions that reflect your values and preferences. 


We will promote transparency and collaboration. Our ethical obligations as providers require that we do no harm. So we commit to protecting your health information. If we are required by law to share the results of drug screenings, we will advise you of that and we will work together to make a plan to help reduce the potential harm of that report.

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The Problem of Shame

One of the great problems in the world is also one of the most invisible, because – by its nature – it asks to be hidden and saps our ability to spot its symptoms. But, to generalise grossly, few things so undermine human well-being as the sickness of shame.

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Implicit Bias - Concepts Unwrapped

Implicit bias exists when people unconsciously hold attitudes toward others or associate stereotypes with them. 

Shared Decision-Making

Advantages for using a shared decision-making process are:


Midwives are uniquely poised to lead the maternity care community in implementing a more meaningful shared decision-making process.   

Shared decision‐making in maternity care: Acknowledging and overcoming epistemic defeaters    Keith Begley, PhD, Deirdre Daly, PhD, Sunita Panda, MSc, and Cecily Begley, PhD 

Communications Between Pregnant Women and Maternity Care Clinicians    Erika R. Cheng, PhD, MPA; Aaron E. Carroll, MD, MS; Ronald E. Iverson, MD, MPH; et al

  • higher client satisfaction

  • more positive relations among the care team

  • higher levels of trust

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Causing Harm 

Causing harm explores the different types of harm that may be caused to people or groups and the potential reasons we may have for justifying these harms.

Informed Consent

Seeking informed consent expresses respect for the patient as a person; it particularly respects a patient’s moral right to bodily integrity, to self-determination regarding sexuality and reproductive capacities, and to support of the patient’s freedom to make decisions within caring relationships.


Urine Drug Testing (UDT)

Appropriate Use of Drug Testing in Clinical
Addiction Medicine  

CONSENSUS STATEMENT - American Society of Addiction Medicine (ASAM) 

Adopted by the ASAM Board of Directors April 5, 2017.

Endorsed by the American College of Medical Toxicology.

Informed Consent and Shared Decision Making in Obstetrics and Gynecology

ACOG Committee Opinion, Number 819 

February 2021

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What Does Ethical Caregiving Look Like?

Project Nurture provides prenatal care, inpatient maternity care, and postpartum care for women who struggle with addictions as well as pediatric care for their infants. 

Project Nurture’s model is to engage women in prenatal care and drug treatment as early in pregnancy as possible, provide inpatient care for their delivery and follow them and their infants for a year postpartum providing case management and advocacy services throughout. 

What Does Ethical Caregiving Sound Like?
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with Dr. Mishka Terplan

with Dr. Neil Seligman

with Dr. David Garry

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