{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T08:13:25Z","timestamp":1790324005448,"version":"4.1.0"},"reference-count":40,"publisher":"Walter de Gruyter GmbH","license":[{"start":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T00:00:00Z","timestamp":1790553600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Shared decision-making pervades perinatal practice, invoked in counseling about prenatal screening, trial of labor after cesarean delivery, vaccination in pregnancy, and place and mode of birth, as though its meaning were settled. It is not. The literature contains several distinct and partly incompatible models of the clinical encounter, and the definitions issued by authoritative bodies, from the American College of Obstetricians and Gynecologists (ACOG) to the Centers for Disease Control and Prevention (CDC), disagree among themselves. From this ambiguity two errors follow: shared decision-making is equated with clinician neutrality, the presentation of options without a recommendation, and it\u00a0is treated as a substitute for informed consent rather than one element within it. We argue, first, that the term should never appear in obstetric guidelines or consent processes without a\u00a0stipulated definition naming the model intended and whether a recommendation is permitted; and second, that the appropriate counseling posture depends on the clinical situation. Neutrality is owed when a perinatal decision is preference-sensitive, as in abortion counseling, trial of labor after\u00a0cesarean, or aneuploidy screening. Neutrality is inappropriate when the evidence clearly favors one course, as\u00a0in\u00a0vaccination in pregnancy or low-dose aspirin prophylaxis for\u00a0preeclampsia, because presenting non-equipoise as equipoise misinforms the woman and can leave two patients unprotected. We examine the 2025 reclassification of US COVID-19 vaccination recommendations in pregnancy as a cautionary case.<\/jats:p>","DOI":"10.1515\/jpm-2026-0479","type":"journal-article","created":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T07:55:32Z","timestamp":1790322932000},"source":"Crossref","is-referenced-by-count":0,"title":["When neutrality misleads: shared decision-making and professional responsibility in perinatal medicine"],"prefix":"10.1515","author":[{"given":"Frank A.","family":"Chervenak","sequence":"first","affiliation":[{"name":"Department of Ethics , Northwell Health , New York , NY , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amos","family":"Gr\u00fcnebaum","sequence":"additional","affiliation":[{"name":"Department of Ethics , Northwell Health , New York , NY , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"374","published-online":{"date-parts":[[2026,9,28]]},"reference":[{"key":"2026092507552838906_j_jpm-2026-0479_ref_001","doi-asserted-by":"crossref","unstructured":"Makoul, G, Clayman, ML. An integrative model of shared decision making in medical encounters. Patient Educ Counsel 2006;60:301\u201312. https:\/\/doi.org\/10.1016\/j.pec.2005.06.010.","DOI":"10.1016\/j.pec.2005.06.010"},{"key":"2026092507552838906_j_jpm-2026-0479_ref_002","doi-asserted-by":"crossref","unstructured":"Bomhof-Roordink, H, G\u00e4rtner, FR, Stiggelbout, AM, Pieterse, AH. Key components of shared decision making models: a systematic review. BMJ Open 2019;9:e031763. https:\/\/doi.org\/10.1136\/bmjopen-2019-031763.","DOI":"10.1136\/bmjopen-2019-031763"},{"key":"2026092507552838906_j_jpm-2026-0479_ref_003","doi-asserted-by":"crossref","unstructured":"Charles, C, Gafni, A, Whelan, T. Shared decision-making in the medical encounter: what does it mean? (Or it takes at least two to tango). Soc Sci Med 1997;44:681\u201392. https:\/\/doi.org\/10.1016\/s0277-9536(96)00221-3.","DOI":"10.1016\/S0277-9536(96)00221-3"},{"key":"2026092507552838906_j_jpm-2026-0479_ref_004","doi-asserted-by":"crossref","unstructured":"Charles, C, Gafni, A, Whelan, T. Decision-making in the physician-patient encounter: revisiting the shared treatment decision-making model. Soc Sci Med 1999;49:651\u201361. https:\/\/doi.org\/10.1016\/s0277-9536(99)00145-8.","DOI":"10.1016\/S0277-9536(99)00145-8"},{"key":"2026092507552838906_j_jpm-2026-0479_ref_005","doi-asserted-by":"crossref","unstructured":"Elwyn, G, Frosch, D, Thomson, R, Joseph-Williams, N, Lloyd, A, Kinnersley, P, et al.. Shared decision making: a model for clinical practice. 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