Why Doctors Should Recommend: Professional Responsibility and Patient Autonomy
A recommendation by me is not the same as an order. When I advise a pregnant patient not to smoke, or to wear a seat belt, I am not controlling her choices.
Imagine if a doctor, when asked whether you should wear a seatbelt, simply said: “It’s up to you.” Or whether you should smoke says: “Your choice”. No mention of safety, no recommendation, no guidance. Would you feel supported—or abandoned?
In medicine, some believe that offering a strong recommendation risks limiting a patient’s autonomy. I believe the opposite is true: making a recommendation is a core part of a doctor’s professional responsibility, and far from restricting autonomy, it strengthens it.
Recommendations Are Not Commands
A recommendation is not the same as an order. When I advise a pregnant patient not to smoke, I am not controlling her choices. She remains free to decide. What I am doing is honoring my obligation as a physician: to evaluate risks, weigh benefits, and translate medical evidence into clear guidance.
Autonomy does not mean a patient should be left without direction. True autonomy is the ability to make an informed choice, and informed choice requires knowing what the evidence shows and what a trusted professional thinks is best.
Seatbelts, Cigarettes, and Alcohol
Seatbelts save lives. We do not hesitate to recommend them because the evidence is overwhelming. Similarly, we advise against smoking and alcohol in pregnancy—not because patients cannot decide for themselves, but because the risks are clear: smoking increases risks of low birth weight and stillbirth; alcohol can cause lifelong fetal alcohol spectrum disorders.
If we were to simply present the data without a conclusion—“Here are the studies, do what you will”—we would fail in our duty. Our professional responsibility means going one step further: based on this evidence, I recommend against smoking and alcohol in pregnancy.
Vaccinations: A Modern Example
The same is true for vaccines. During pregnancy, vaccines such as influenza, pertussis (whooping cough), and COVID-19 protect not only the mother but also the baby. To say “vaccination is an option” without adding, “I strongly recommend it” is to blur the difference between a proven lifesaving intervention and personal preference.
Recommending vaccination is not coercion. It is guidance. The patient may decline, but she should know clearly what her doctor believes is safest for her and her baby.
Food, Weight, and Everyday Choices
Doctors also have a responsibility to recommend healthier daily choices—choosing nutritious foods, exercising safely, and, when appropriate, losing weight. These are sensitive topics, but silence helps no one. Obesity increases the risk of complications in pregnancy, including diabetes, preeclampsia, and cesarean delivery.
If a physician avoids making a recommendation for healthier eating or weight loss because it might be uncomfortable, the patient is left without direction. Offering respectful, supportive guidance—“I recommend focusing on whole foods, fruits, vegetables, and gradual weight loss before pregnancy”—is not judgment. It is advocacy.
The Myth of Neutrality
Some physicians fear that making recommendations crosses into paternalism. They retreat into “neutral” territory: documenting the patient’s refusal, re-offering later, but never strongly advocating.
But neutrality is not neutral—it is abandonment. It leaves patients to navigate life-and-death decisions without the compass of professional judgment. A doctor who refuses to recommend is like a pilot who tells passengers, “We could land safely on the runway, or we could try the mountain—your choice.”
Yes, patients have the right to choose the mountain. But they deserve to know which option the expert believes is safest.
Autonomy Requires Direction
Think of autonomy like driving. The driver chooses where to go, but the GPS provides guidance. Without directions, the driver is not “more free”; they are more likely to get lost.
In the same way, patients are more autonomous when doctors recommend clearly—for vaccines, healthy foods, or weight management, and against smoking or alcohol. It provides them with orientation, evidence, and professional judgment. Autonomy without guidance is not autonomy—it is confusion.
When We Fail to Recommend
Consider pregnancy complicated by total placenta previa, where vaginal delivery can cause catastrophic hemorrhage. If a patient refuses a cesarean, simply documenting “refusal” and moving on is not enough. The professional responsibility is to re-engage, explain the stakes, dispel myths, and advocate for safety.
It is not ethically defensible to remain “neutral” while both mother and baby face preventable death. The physician must recommend: Cesarean delivery is necessary to save your life and your baby’s life. The patient may still refuse. But the recommendation fulfills the physician’s duty to advocate for health and life.
The Balance: Responsibility and Respect
Professional responsibility and patient autonomy are not opposites. They work together. My role as a doctor is to make recommendations grounded in science and ethics. The patient’s role is to consider those recommendations, ask questions, and make a choice consistent with their values and circumstances.
When patients feel their autonomy is respected and that they have clear professional guidance, trust grows. They may not always agree, but they know the doctor is not hiding behind neutrality.
Lessons for Patients and Physicians
For patients: If your doctor makes a recommendation, know it is not meant to limit your freedom. It is meant to give you clarity and support. Ask questions, weigh your values, and decide—but take the recommendation seriously.
For physicians: Do not confuse neutrality with respect. Respect means listening and engaging, but also speaking clearly when evidence points strongly for or against an option.
For both: Remember that autonomy is strengthened, not weakened, when professional responsibility is fulfilled.
Closing Reflection
The essence of medicine is not passive neutrality. It is active responsibility. To recommend for seatbelts, for vaccines, for healthy food, and for weight loss; and against alcohol and smoking in pregnancy is not an infringement on autonomy—it is an affirmation of it.
The ethical question is this: When lives are at stake, is it more respectful to remain neutral, or to offer the clear recommendation that patients deserve?