Caring With, Not For: Reconstructing Beneficence and Autonomy in Obstetric Ethics After Dobbs

The post-Dobbs v Jackson Women's Health Organization legal landscape has revived older forms of medical paternalism in obstetric care, where physicians are increasingly positioned as moral arbiters between the pregnant woman and the fetus. This paper argues that both law and clinical practice have entrenched a two-patient fiction that fractures beneficence into competing loyalties, undermining the moral agency of the pregnant person. Drawing on feminist and relational theories of autonomy, particularly the work of Jennifer Nedelsky and Catriona Mackenzie, the paper reconstructs beneficence as a relational rather than paternalistic virtue. It proposes a framework of "relational beneficence" in which care is exercised with rather than for the patient, emphasizing dialogue, trust, and mutual moral reasoning. Integrating insights from Ubuntu ethics, the argument situates dignity and autonomy within interdependence, offering a cross-cultural foundation for ethical obstetric practice. By examining legal developments that confer fetal personhood and compel clinical compliance, the paper demonstrates how statutory frameworks transform moral responsibility into enforcement, eroding trust and professional integrity. It concludes that genuine beneficence in obstetric ethics must recognize the unity of maternal and fetal interests as lived within one embodied moral agent. Ethical care thus requires partnership, not protection, and law should reflect this relational understanding by supporting-not supplanting-the moral agency of pregnant persons.