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The Doctor's Dilemma: Paternalisms in the Medicolegal History of Assisted Reproduction and Abortion

In 1954, American women experienced an unwanted pregnancy as presenting a difficult choice between bearing an unwanted child and risking an illegal abortion. Yet obstetrician/gynecologist Alan Guttmacher described abortion as “the doctor’s dilemma.” Guttmacher and his medical colleagues experienced a dilemma when their professional judgment that pregnancy termination was warranted clashed with the laws criminalizing most abortions. In that situation, the law constrained their ability to make a decision they felt to be in the best interest of a patient. To doctors, such paternalist decision-making was a bedrock principle of 20th-century medicine. Doctors had an obligation to provide, or deny, treatment to patients for their own good. This duty arose from medical expertise and separated the medical profession from lesser medical practitioners.