{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T21:44:35Z","timestamp":1792100675395,"version":"4.4.0"},"reference-count":28,"publisher":"Springer Science and Business Media LLC","license":[{"start":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T00:00:00Z","timestamp":1792022400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T00:00:00Z","timestamp":1792022400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["HEC Forum"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Gestational diabetes mellitus (GDM) sits at the intersection of maternal bodily integrity, fetal risk mitigation, and healthcare equity, and rigid guideline enforcement can trigger bedside conflicts and institutional friction. This article examines GDM management through the deliberative model of the Spanish physician and philosopher Diego Gracia, influential in Southern Europe and Latin America but less familiar in North America, which separates moral duties into Level I (Non-Maleficence and Justice) and Level II (Autonomy and Beneficence). We explain why we start from Gracia rather than from Beauchamp and Childress: his model couples a defeasible ordering of duties with an explicit deliberative procedure that institutions can teach and document. We then argue against a misreading of the model in perinatal care that places fetal protection at Level I and maternal decision-making at Level II. Maternal bodily integrity and informed refusal also engage Level I non-maleficence duties, so bedside conflicts are better understood as clashes between two Level I obligations. We extend this reframing by translating Gracia\u2019s deliberative steps into a consultation protocol for Healthcare Ethics Committees (HECs), by using international variation in metformin\u2019s regulatory standing to show that pharmacological choice involves value judgments, and by treating access to glucose self-monitoring supplies as a matter of distributive justice. A hypothetical, composite vignette illustrates the protocol. The proposals are conceptual and untested; we suggest that structured deliberation may help institutions honor maternal self-determination without abandoning fetal interests.<\/jats:p>","DOI":"10.1007\/s10730-026-09619-3","type":"journal-article","created":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T20:51:21Z","timestamp":1792097481000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Bioethical Deliberation in Gestational Diabetes Management: Integrating Diego Gracia\u2019s Model into Clinical Ethics Consultation and Institutional Policy"],"prefix":"10.1007","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8178-2136","authenticated-orcid":false,"given":"F\u00e1bio R.","family":"Cabar","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8828-6725","authenticated-orcid":false,"given":"Rafaela A.","family":"da Costa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,10,15]]},"reference":[{"issue":"Suppl 1","key":"9619_CR1","doi-asserted-by":"publisher","first-page":"S282","DOI":"10.2337\/dc24-S015","volume":"47","author":"American Diabetes Association Professional Practice Committee","year":"2024","unstructured":"American Diabetes Association Professional Practice Committee. (2024). 15. Management of diabetes in pregnancy: Standards of care in diabetes-2024. Diabetes Care, 47(Suppl 1), S282\u2013S294. https:\/\/doi.org\/10.2337\/dc24-S015","journal-title":"Diabetes Care"},{"key":"9619_CR2","volume-title":"Principles of biomedical ethics","author":"TL Beauchamp","year":"2019","unstructured":"Beauchamp, T. L., & Childress, J. F. (2019). Principles of biomedical ethics (8th ed.). Oxford University Press.","edition":"8th ed."},{"issue":"3","key":"9619_CR3","doi-asserted-by":"publisher","first-page":"115","DOI":"10.1002\/(SICI)1520-6661(199605\/06)5:3<115::AID-MFM5>3.0.CO;2-8","volume":"5","author":"FA Chervenak","year":"1996","unstructured":"Chervenak, F. A., & McCullough, L. B. (1996). The fetus as a patient: An essential ethical concept for maternal-fetal medicine. 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The association between early diagnosis of gestational diabetes and maternal-neonatal outcomes: A secondary analysis of the DiGest trial. Endocrine, 91, 87. https:\/\/doi.org\/10.1007\/s12020-025-04542-y","journal-title":"Endocrine"},{"key":"9619_CR8","doi-asserted-by":"publisher","DOI":"10.1007\/s00592-026-02644-1","author":"N Gautam","year":"2026","unstructured":"Gautam, N., de Souza, B. L., Abramowitz, J., et al. (2026). Continuous glucose monitoring versus self-monitoring of blood glucose in gestational diabetes: An updated systematic review and meta-analysis of randomized controlled trials. Acta Diabetologica. https:\/\/doi.org\/10.1007\/s00592-026-02644-1","journal-title":"Acta Diabetologica"},{"issue":"2\u20133","key":"9619_CR9","doi-asserted-by":"publisher","first-page":"97","DOI":"10.1111\/j.1467-8519.1993.tb00276.x","volume":"7","author":"D Gracia","year":"1993","unstructured":"Gracia, D. (1993). The intellectual basis of bioethics in southern European countries. 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WHO recommendations on care for women with diabetes during pregnancy."}],"container-title":["HEC Forum"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10730-026-09619-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s10730-026-09619-3","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10730-026-09619-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T20:51:23Z","timestamp":1792097483000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s10730-026-09619-3"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,15]]},"references-count":28,"alternative-id":["9619"],"URL":"https:\/\/doi.org\/10.1007\/s10730-026-09619-3","relation":{},"ISSN":["0956-2737","1572-8498"],"issn-type":[{"value":"0956-2737","type":"print"},{"value":"1572-8498","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,15]]},"assertion":[{"value":"10 September 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"1 October 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"15 October 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare no competing interests.","order":1,"name":"Ethics","label":"Competing Interests","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This is a theoretical bioethical article and does not involve empirical research with human participants or animals. Institutional Review Board (IRB) approval was not required.","order":2,"name":"Ethics","label":"Ethical Approval","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The clinical vignette included in Section 5 is an anonymized composite case constructed purely for educational and deliberative analysis. It does not represent an actual individual patient, and no identifiable private personal health information is contained herein.","order":3,"name":"Ethics","label":"Informed Consent","group":{"name":"EthicsHeading","label":"Declarations"}}]}}