There are moments in clinical life when science and experience converge in a way that shapes one’s understanding. For me, one such moment occurred on a cold night (-40 C/ -40 F) under the northern lights in Iqaluit, Nunavut. Standing in the Arctic night, watching luminous green arcs moving across a vast and silent sky, I found myself thinking about existence, culture, trauma, psychiatry, psychotherapy, and healing.

Watching the aurora is an unforgettable experience, both for its overwhelming beauty and for the stories and remarkable science that lie behind it. Traditionally, in many Inuit stories, the aurora was understood as the movement and presence of ancestral spirits, reflecting continuity between worlds. The sky was not considered an empty background but part of a living universe in which humans, animals, spirits, and natural forces remained interconnected. Yet the phenomenon is a precise and well-understood interaction between solar and terrestrial forces. Charged particles emitted from the sun, carried by the solar wind, are drawn toward the Earth’s polar regions by the planet’s magnetic field. When these high-energy particles collide with atoms in the upper atmosphere, primarily oxygen and nitrogen, they transfer energy that is then released as light (1). The aurora is therefore not a self-generated beauty; ….

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Design/methodology/approach: This viewpoint presents a rights-based ethical reflection informed by a narrative synthesis of current evidence, including the US Food and Drug Administration’s 2025 expert panel on SSRIs during pregnancy, and the literature from perinatal psychiatry, medical ethics, human rights and public health communication. The paper explores how scientific uncertainty, risk communication and social context influence treatment decisions during pregnancy.

Findings: The debate surrounding SSRI use during pregnancy is frequently framed as a binary choice between protecting foetal well-being and treating maternal mental health conditions. Such polarised narratives risk oversimplifying a complex evidence base and may undermine informed decision-making. Current evidence suggests that both untreated perinatal mental health conditions and pharmacological treatment involve potential risks and uncertainties. A rights-based approach requires balanced communication, recognition of relational autonomy, attention to structural inequalities and meaningful participation of pregnant women in decisions affecting their health and well-being.

Originality/value: Existing discussions have largely focused on pharmacological safety, maternal mental health outcomes and foetal risks. Comparatively less attention has been paid to how human rights principles, including autonomy, participation, informed consent and reproductive justice, should guide decision-making under conditions of scientific uncertainty. This paper addresses that gap by reframing SSRI decision-making during pregnancy through the lenses of autonomy, participation, informed consent, reproductive justice and rights-based mental healthcare. It advocates a shift from paternalistic and polarised approaches towards more collaborative, person-centred and ethically grounded care….

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