Ethical and medicolegal issues
Ethics in obstetrics and gynecology
- The Hippocratic oath emphasizes the virtues that were historically expected to characterize and guide the behavior of physicians and other healthcare professionals who swore to practice medicine ethically and honestly.
- The vast expansion of medical technology over the past several decades has led to increasingly complex ethical questions for obstetrician–gynecologists.
- The availability of assisted reproductive technology, preimplantation genetics, selective abortion, and earlier gestational age viability is a sample of the dilemmas commonly encountered.
- Medical ethics is currently dominated by four tenets of principle-based ethics (Figure 18.1).
- These major principles may be used as guides to professional action. However, conflicts will still arise – requiring the physician to determine which principle(s) should have priority.
- Obstetric/gynecology (Ob/Gyn) physicians often face a conflict between principles of beneficence and nonmaleficence because a pregnant woman actually represents two patients.
- Frequently, more than one course of action may be morally justifiable, whereas in others no course of action seems acceptable because each may result in significant harms or else compromise important principles or values. Yet, the clinician must select one of the available options and be able to justify that decision with ethical reasons.
- The involvement of individuals with a variety of backgrounds and perspectives can be useful in addressing ethical questions. Consultation with a social worker or hospital ethics committee may be advantageous.
- Guidelines (Figure 18.2), consisting of several logical sequential steps, can aid the practitioner in analyzing and resolving an ethical problem.
- Ob/Gyn physicians who are familiar with the concepts of medical ethics will be better able to approach complex situations in an objective, structured way and minimize the likelihood of anger, injury, or litigation.
