Page last updated: Thursday, June 18, 2009
Is UK medical advice on prenatal alcohol use really accurate?
Colin Gavaghan, of the School of Law at the University of Glasgow has published an article in Journal of Medical Ethics questioning the advice of UK doctors on drinking during pregnancy. He asserts that such advice is often condecending and morally uncertain, including the recommendations of the Chief Medical Officer for England and the British Medical Association (BMA).

Gavaghan states that, unlike heavy drinking, when consumption is reasonable and moderate, studies still do not conclude that it can cause harm to the developing fetus. Regardless of lack of new evidence, the UK government and the BMA changed their recommendations from ‘one to two units once or twice a week’ in 2007, advising total abstinence during pregnancy. However, a year later, the National Institute for Health and Clinical Excellence (NICE), and researchers from The University of London claimed that there was no support of proof of damage, as long as women drank no more than one or two units per week. The investigation even established that the children of mothers who drank moderately during gestation had fewer behavioural and developmental problems than those whose mothers abstained entirely.

Unfortunately, when in doubt, most doctors advice abstinence, but for several reasons Dr Gavaghan argues that this simply should not be the case. He remarks that healthcare in general has changed from paternalism to choice and autonomy, a vital part of which is supplying information to allow patients to make educated decisions. When there is uncertainty in the evidence, doctors should disclose it, rather than taking the easy option and avoid trying to clarify it, he argues. “It is not reasonable to replace more accurate information with less accurate merely because it is simpler to communicate,” he writes.

According to Dr. Gavaghan time of abstinence could be rather long, since many doctors also advise women to refrain from drinking when trying to get pregnant.

“It may be thought that, at the very least, we should require some reasonably compelling ethical justification for what is, on the face of it, a straightforward sexist policy. To date, the evidence suggests that we have no such justification,” he says. He suggests that such methods might go wrong and have negative effects in the long run. “If [doctors] are seen to be exaggerating risks that recent studies have shown to be negligible, their advice on genuine risks will carry less authority.”

Source: “You can’t handle the truth: medical paternalism and prenatal alcohol use.” J Med Ethics 2009; 35: 300-303

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