T he practice of contemporary medicine incorporates the social aspects of many health problems. This recognition of the interaction between health and social issues has forced health care providers to redefine and broaden their roles. However, many recently proposed solutions to social problems require health care professionals to play roles in other systems’ agendas that go well beyond the dictates of their profession and may compromise the effectiveness of their work. This is happening in many hotly contested areas of social policy, such as physician participation in capital punishment, the reporting of undocumented patients to immigration authorities, and the restriction of medical intervention in the managed care context.“’As this blurring of roles occurs in the field of reproductive health we must be concerned about the consequences for medicine, for the patient, and for the public. Sometimes these developments implicate obstetricians in activities that may not be consonant with the traditional definition of their role or their professional ethics and may, in fact, not be furthering the intended public health goals. These developments have far reaching ramifications for both medical integrity and reproductive autonomy and therefore warrant close scrutiny.

Many of the issues related to the boundaries of professionalism have previously been debated in the context of psychiatry, and with regard to the identification and treatment of HIV infection and drug addiction. In this article, we propose to examine the sophisticated arguments developed in these contexts and assess their relevance to recent developments in reproductive health.