Professionally responsible COVID-19 vaccination counseling—response to Chervenak et al

Abstract

In their article, Chervenak et al1Chervenak F.A. McCullough L.B. Bornstein E. et al.Professionally responsible coronavirus disease 2019 vaccination counseling of obstetrical and gynecologic patients.Am J Obstet Gynecol. 2021; 224: 470-478Abstract Full Text Full Text PDF PubMed Scopus (39) Google Scholar designated their favored approach to counseling pregnant women for COVID-19 vaccination as “professionally responsible.” However, their stance diverges in important aspects from product licenses and guidance issued by professional bodies. Their approach aims to increase vaccine uptake. Their view is rooted in willingness to view caution as necessarily or primarily a legalistic concern, coupled with their readiness to substitute experiment-based scientific evidence with inferences or suppositions. The seriousness of COVID-19 is not in doubt. Remarkable scientific progress enabled vaccine development and emergency use authorization in record time. The technology used in most COVID-19 vaccines is novel. There is cause for optimism, but vaccines have not been tested in pregnant women. Emerging information emphasizes the value of surveillance and monitoring, which should include long-term fetal outcomes. The authors built their argument based on extrapolations from short-term data derived from research on nonpregnant adults. They need to provide an account of how this lower standard of proof can be adopted without undermining medicine’s claim to be rooted in scientific rigor. Doctors have considerable influence on patients’ choices. This stems from the trust patients bestow on doctors. Chervenak et al1Chervenak F.A. McCullough L.B. Bornstein E. et al.Professionally responsible coronavirus disease 2019 vaccination counseling of obstetrical and gynecologic patients.Am J Obstet Gynecol. 2021; 224: 470-478Abstract Full Text Full Text PDF PubMed Scopus (39) Google Scholar view this trust as an opportunity to channel patients’ choices. However, they need to address the concern that their approach risks undermining the fiduciary relationship and the essence of trust. In addition, they need to provide an account as to how to reconcile “respect” for autonomy with advocating persistent efforts to sway women toward a particular choice or to reverse expressed preferences. Counseling for consent ought not to be grounded in a conviction that particular choices are irrational or irresponsible. Thus, Chervenak and colleagues need to describe how to reconcile the tension inherent in providing care with the standpoint that pregnant women who hesitate about vaccination are free riders and, as such, morally reprehensible. At the core, Chervenak et al1Chervenak F.A. McCullough L.B. Bornstein E. et al.Professionally responsible coronavirus disease 2019 vaccination counseling of obstetrical and gynecologic patients.Am J Obstet Gynecol. 2021; 224: 470-478Abstract Full Text Full Text PDF PubMed Scopus (39) Google Scholar seek to influence value judgments. Pregnant women and care providers face a dilemma when balancing the risks to public health, the individual woman, and the unborn baby. It is difficult to see how labeling a particular stance as “responsible” can be helpful. Alternatively, Chervenak and colleagues should clarify why they believe pregnant women need to provide a reason or justify their choice. Professionally responsible coronavirus disease 2019 vaccination counseling of obstetrical and gynecologic patientsAmerican Journal of Obstetrics & GynecologyVol. 224Issue 5PreviewThe development of coronavirus disease 2019 vaccines in the current and planned clinical trials is essential for the success of a public health response. This paper focuses on how physicians should implement the results of these clinical trials when counseling patients who are pregnant, planning to become pregnant, breastfeeding or planning to breastfeed about vaccines with government authorization for clinical use. Determining the most effective approach to counsel patients about coronavirus disease 2019 vaccination is challenging. Full-Text PDF Reply to professionally responsible COVID-19 vaccination counselingAmerican Journal of Obstetrics & GynecologyVol. 225Issue 3PreviewWe thank Dr Habiba for his interest in our article.1 Dr Habiba claims that our article failed to be “rooted in scientific rigor” because “vaccines have not been tested in pregnant women” in a randomized controlled clinical trial. In February 2021, Pfizer and BioNTech embarked on studying the effects of COVID-19 vaccination on pregnant women. Before the results of trial data, it was necessary to protect pregnant and lactating patients through emergency access and advocate for their participation in research. Full-Text PDF