Knowledge and technologic advancements have created a myriad of new screening, diagnostic, and treatment options for women of reproductive age. These new options often raise ethical issues as the women, their health care professionals, and society adapt to the benefits while coping with the pressures and burdens these options create. Threats to accomplishing the good that midwifery strives to contribute to health care for the benefit of women are identified from the perspective of the midwife's instrumental and expressive roles. Suggestions are presented for resolving ethical dilemmas that may occur in the selection and implementation of health care options. A distinction is made between midwifery practice at the microlevel, which achieves the good through direct interaction with the woman, and the institutional macrolevel that promotes accomplishing the good in reproductive health care through policy development and management decisions.