Pezi Veronica^Mang1,2, Katja Kühlmeyer²

^{1 Institute} for Medical Information Processing, Biometrics and Epidemiology (IBE), Ludwig Maximilian University of Munich, Pettenkofer School of Public Health, Munich

^{2 Institute} for Ethics, History and Theory of Medicine, Ludwig Maximilian University of Munich

Advance Care Planning (ACP) is a process-oriented approach designed to bring forward medical treatment decisions and to make provisions for situations where a person may become (or is at risk of becoming) incapable of giving consent. The approach is based on the assumptions that treatment decisions can also be justified by prospective autonomy and that self-determined treatment decisions are ethically preferable to those determined by others.

ACP was developed specifically for treatment decisions concerning the end of life. To date, the approach has received little attention in the context of advance planning for childbirth. Here, ACP has the potential to increase the likelihood that treatment during childbirth will be in line with the preferences of the woman giving birth. Current research on ACP in the context of childbirth neglects the woman giving birth and focuses on the (palliative) treatment of the (unborn) child. Against this background, this paper examines how ACP for medically assisted births should be assessed from an ethical perspective. The basis for the ethical assessment is professional ethics, grounded in the reconstruction of professional ethical duties.

The article first explains the characteristics of hospital births and the treatment decisions (e.g. preference-based and emergency decisions) that are made in this context. Emergencies are particularly time-critical and complex, as measures indicated for the woman in labour may also have undesirable consequences for the (unborn) child. The article then discusses the extent to which restrictions on the capacity for self-determination are to be expected during childbirth. The concept of ACP is then introduced and considered in relation to the current state of birth planning. In the next step, the professional areas of responsibility of the relevant professional groups in this setting are identified, and it is clarified to what extent ACP would support or restrict the fulfilment of professional ethical obligations in this context. Here, we draw on the findings of a qualitative interview study in which experts were interviewed. Finally, we arrive at an ethical assessment of whether ACP appears appropriate for the advance planning of medically assisted births and highlight areas where changes are needed in current care practice.