This research proposal is designed, first, to investigate the effects of active involvement by expectant couples in medical decision making, and, second, to evaluate the effect of this involvement on the couples' desires for obstetric and pediatric health care. Toward these ends, three steps are proposed. The first step will be to determine the criteria by which expectant couples both select and evaluate health care services. This information will be used to investigate the extent to which the desires of expectant couples are being met. The second step will be to determine the factors that influence the willingness of couples to participate in the medical decision making process. Particular attention will be paid to both the amount and form of information available to couples about medical alternatives. The final step will be to determine the effect of active input from expectant couples on the attribution of responsibility for decision outcomes. This research will also allow analysis of how different levels of patient involvement influence the assessment of risks and the judged adequateness of informed consent. For all steps, expectant couples will be asked about real and hypothetical decisions related to obstetric, hospital, and pediatric care. These decisions will be made both before and after childbirth. The primary methodology in initial research will be based on multiattribute utility procedures; this approach will be used, for instance, to determine the relevant health care dimensions. More detailed investigations into couples' willingness to participate in medical decisions, assignment of responsibility for various outcomes, and assessment of risks involved will be carried out using information integration techniques. Such techniques will also permit evaluation of the psychological values and decision strategies used by various couples.