Friends in Adoption (FIA) Case Manager Nan Pasquarello comments on the Ethics guidelines released by The American College of Obstetricians and Gynecologists (ACOG) Committee on Ethics. These Guidelines are for OB-GYNs working with patients considering adoption. Nan Pasquarello's comments below were originally published in the Winter 2013 Edition of the FIA Newsletter: "Connections."
To read the original opinion article published by the American College of Obstetricians and Gynecologists (ACOG) Committee on Ethics, click HERE.
- by: Nan Pasquarello, Case Manager
This past summer, The American College of Obstetricians and Gynecologists (ACOG) Committee on Ethics issued a Committee Opinion that clarifies best practice for physicians with regard to adoption. The articulated guidelines will benefit women and couples who are considering adoption for their babies. This article summarizes highlights from the recent opinion and shares its recommendations.
It makes sense that OB-GYN physicians, who are experts on infertility, pregnancy, and childbirth will be asked for advice and counsel with regard to adoption. The ACOG focuses on the fact that a doctor’s primary duty is to his or her own individual patient, and that ethical and legal considerations guide this responsibility.
Five general recommendations have been put forth in the most recent Committee on Ethics Opinion (ACOG, June 2012):
- Physicians have a responsibility to provide information about adoption to appropriate patients. The information provided should be accurate and as free as possible of personal bias and opinions.
- A physician’s primary responsibility in caring for a woman considering adoption is to her and not to the prospective adoptive parents.
- Physicians should be aware of adoption resources in their areas and refer patients to licensed adoption agencies.
- When physicians complete medical screening forms for prospective adoptive parents, the physician’s role is to provide truthful, accurate information to screening agencies.
- Because of ethical issues related to undue influence, competing obligations, and lack of expertise, physicians should not serve as brokers of adoptions.
“I am not prepared to be a parent.” “I am thinking about terminating this pregnancy.” “I might want to look into adoption.” These are statements a patient might make to her health care provider, and the doctor (and his or her representing support staff) may carry a great deal of influence with his or her response. Therefore it is imperative that factual information rather than opinion is conveyed in the doctor-patient conversation. Women or couples who are experiencing infertility issues may similarly ask their physician about options, and a discussion about adoption may likely be part of that conversation.
Physicians and their staff members who are aware of adoption resources are best able to present facts to patients and refer the patient to adoption experts. As the ACOG opinion discusses, adoption processes have evolved over time, and have become increasingly complex. Among those complexities to be considered are issues of legal consent by birth mothers and birth fathers, revocation periods, different types of adoptions, differing state and international laws, and degrees of openness in adoption. Due to the ever-changing climate of adoption, negotiating these areas can be challenging, and therefore, patients are better served to be referred to licensed adoption agencies and trained professionals.
Physicians might find they are facing a conflict of interest when working with women (or couples) who wish to place their child for adoption as well as individuals who wish to adopt. The ACOG clearly articulates that it is not appropriate for physicians to serve as adoption brokers in any way. Many hospitals prohibit this activity. Further, adoption professionals are best left to the matching of birth parents and adoptive parents, so it is recommended that OB-GYNs not take on the practice of matching these parties. Rather, serving the individual patients, providing accurate information and medical screening, and referring them to expert resources are considered best practice.
A physician’s support of a birth mother’s plan can be of utmost importance before, during, and after placement. Adoption counselors and professionals often assist in helping birth parents negotiate the emotions that accompany the process. The ACOG opinion shares how in the past it was believed that it was best for a birth mother to not see or hold her newborn baby prior to placement. Today, however, depending on a birth mother’s wishes, she may choose to spend time with the baby, and even breast feed the baby. This contact between the birth mother and baby has been found to help make the adoption plan real, and help a woman / couple confirm the decision and help process the natural grief associated with placing a child for adoption. A physician’s knowledge of hospital policies and communication with the patient and staff can ensure proper care of a birth mother during this emotional time.
When asked how the new ACOG recommendations benefit patients considering adoption, licensed mental health counselor Laurie Coreno Reynolds, who specializes in adoption counseling, had this to say: “Pregnant women and teens often look to their Ob/Gyn for guidance and direction when dealing with an unplanned pregnancy. Physicians have an ethical obligation to be objective when talking to a pregnant woman about adoption and not allow their personal feelings to interfere.” Coreno Reynolds also offered that, “adoption should always be presented as an option, in the same way that all other pregnancy options are present. A woman facing an unplanned pregnancy needs to know there are choices if she does not feel she is prepared to parent.”
The ACOG has called upon OB-GYN practitioners to learn about best-practice adoption services and become knowledgeable about licensed agencies and adoption counselors who can be resources to pregnant women considering adoption. These physicians play a vital role in supporting an adoption plan if that is the chosen route of the patient.
The Committee on Ethics Opinion concludes, “Obstetricians who care for pregnant women considering adoption play an important role in providing the medical and emotional support these women deserve. Supporting these women through the process of relinquishing their children while sharing in the joy of the adoptive parents can be a challenge, but one that embraces the art and science of medicine. The obstetrician’s obligation to the pregnant woman, however, remains paramount.”
To read the full background and opinion, please visit the ACOG web site, and source for this article: http://www.acog.org/Resources_And_Publications/Committee_Opinions/Committee_on_Ethics/Adoption [June 2012, accessed 1/14/2013]