"Doctor, what would you do in my position?" : health professionals and the decision-making process in pregnancy monitoring

Objective: Routine prenatal screening for Down syndrome challenges professional non-directiveness and patient autonomy in daily clinical practices. This paper aims to describe how professionals negotiate their role when a pregnant woman asks them to become involved in the decision-making process implied by screening. Methods Forty-one semi-structured interviews were conducted with gynaecologists–obstetricians (n=26) and midwives (n=15) in a large Swiss city. Results Three professional profiles were constructed along a continuum that defines the relative distance or proximity towards patients’ demands for professional involvement in the decision-making process. The first profile insists on enforcing patient responsibility, wherein the healthcare provider avoids any form of professional participation. A second profile defends the idea of a shared decision making between patients and professionals. The third highlights the intervening factors that justify professionals’ involvement in decisions. Conclusions These results illustrate various applications of the principle of autonomy and highlight the complexity of the doctor–patient relationship amidst medical decisions today.