Physician hesitancy is said to occur when physicians do not recommend COVID-19 vaccination, and it is a contributing factor for the low vaccination rate for COVID-19 in pregnant women. Physician hesitancy has become a major, unaddressed problem with regard to the quality and safety of obstetrical care. We identify 3 root causes of physician hesitancy and describe how professional ethics in obstetrics should guide in reversing these root causes. They are clinical misapplications of key components of professionally responsible obstetrical practice: therapeutic nihilism, shared decision-making, and respect for patient autonomy. Therapeutic nihilism directs the obstetrician to avoid any clinical interventions during pregnancy to prevent teratogenic effects that might be unknown. Therapeutic nihilism is misapplied when there is a documented net clinical benefit with no evidence of clinical harm. Shared decision directs the obstetrician to only offer but not recommend clinical management. Shared decision-making plays a major role when there is uncertainty in clinical judgment but is misapplied when it becomes a universal model. It does not apply when there is a net clinical benefit. When there is a net clinical benefit, clinical management should be recommended, not simply offered. The ethical principle of respect for patient autonomy plays an indispensable role in decision-making with patients. It is misapplied when it is assumed that respect for autonomy requires physicians not to make recommendations and to defer to and implement patients’ decisions without exception. There is evidence that the obstetrician’s recommendations about the management of pregnancy are the most important factor in a pregnant woman’s decision-making. Simply deferring to the patient’s decisions makes for misapplied respect for patient autonomy. Obstetricians must end physician hesitancy about COVID-19 vaccination of pregnant women by reversing these 3 root causes of physician hesitancy. Reversing the root causes of physician hesitancy is an urgent matter of patient safety. The longer physician hesitancy continues and the longer the low vaccine acceptance rate of pregnant women lasts, preventable serious diseases, deaths of pregnant women, intensive care unit admissions, stillbirths, and other maternal and fetal complications of unvaccinated women will continue to occur. Physician hesitancy should not be permitted to influence the response to future pandemics.

据说，当医生不建议接种 COVID-19 疫苗时，就会出现医生犹豫，这是孕妇 COVID-19 疫苗接种率低的一个因素。医生的犹豫已成为产科护理质量和安全方面一个尚未解决的主要问题。我们确定了医生犹豫不决的 3 个根本原因，并描述了产科职业道德应如何指导扭转这些根本原因。它们是对专业负责的产科实践关键组成部分的临床误用：治疗虚无主义、共同决策和尊重患者自主权。治疗虚无主义指导产科医生在怀孕期间避免任何临床干预，以防止可能未知的致畸作用。当有记录的净临床益处而没有临床危害的证据时，治疗虚无主义就被误用了。共同决策指示产科医生仅提供但不推荐临床管理。当临床判断存在不确定性时，共同决策会发挥重要作用，但当它成为通用模型时，就会被误用。当有净临床效益时，它不适用。当存在净临床效益时，应建议而不是简单地提供临床管理。尊重患者自主权的伦理原则在患者决策中发挥着不可或缺的作用。当认为尊重自主权要求医生不提出建议并毫无例外地服从和执行患者的决定时，它就被误用了。有证据表明，产科医生关于妊娠管理的建议是孕妇决策中最重要的因素。 简单地遵从患者的决定会导致对患者自主权的错误尊重。产科医生必须通过扭转医生犹豫不决的这 3 个根本原因，结束医生对孕妇接种 COVID-19 疫苗接种的犹豫不决。扭转医生犹豫的根本原因是患者安全的紧迫问题。医生犹豫持续的时间越长，孕妇疫苗接受率低的情况持续的时间越长，可预防的严重疾病、孕妇死亡、入住重症监护室、死产以及未接种疫苗的妇女的其他母婴并发症就会继续发生。不应允许医生的犹豫不决影响对未来流行病的反应。