Common ethical dilemmas encountered in the management of HIV-infected women and newborns.

The clinical management of the HIV-infected pregnant woman and newborns involves multifaceted ethical challenges. We have argued that rights-based approaches, based on a civil rights model, are not adequate to clinically address these challenges. We have argued instead for a more nuanced ethical framework that emphasizes the beneficence-based obligations of the physician of the pregnant woman, to the fetal patient, and to the newborn, as well as the beneficence-based obligations of the pregnant woman to the fetal patient and to the newborn. The ethical principle of respect for autonomy shapes the counseling process about termination of pregnancy, contraception, and advance directives.