Ethics in perinatal medicine:
Gespeichert in:
| Format: | Buch |
|---|---|
| Sprache: | English |
| Veröffentlicht: |
Philadelphia [u.a.]
Saunders
2003
|
| Schriftenreihe: | Clinics in perinatology
30,1 |
| Schlagworte: | |
| Online-Zugang: | Inhaltsverzeichnis |
| Beschreibung: | XIV, 187 S. Ill., graph. Darst. |
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| 650 | 4 | |a Fetus |x Surgery |x Moral and ethical aspects | |
| 650 | 4 | |a Fetus |x surgery | |
| 650 | 4 | |a Medical ethics | |
| 650 | 4 | |a Perinatology |x Moral and ethical aspects | |
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CONTENTS
Preface xi
Frank A. Chervenak and Laurence B. McCullough
Education in Ethics 1
Gordon M. Stirrat
Among the purposes of education in ethics are the development
of consistent, critical, and reflective attitudes to ethical decision
making; increasing awareness of ethical dilemmas in one s own
practice and that of others; and reinforcement of best practices in
clinical and research governance.
Words Matter: Nomenclature and Communication in
Perinatal Medicine 17
Lachlan de Crespigny
Language has been shown to have a powerful impact on how the
listener perceives reality and remembers events. This has resulted
in communities becoming aware of the importance of avoiding
sexist and discriminatory language. It is time we in our specialty
focused on the importance of language.
The Beginning of Human Life and Its Modern
Scientific Assessment 27
A. Kurjak
One of the most controversial topics in modern bioethics, science,
and philosophy is the beginning of individual human life. In the
seemingly endless debate, strongly stimulated by recent techno¬
logic advances in human reproduction, a synthesis between scien¬
tific data and hypothesis, philosophical thought, and issues of
humanities has become a necessity to deal with ethical, juridical,
VOLUME 30 • NUMBER 1 • MARCH 2003 v
and social problems. Furthermore, in this field there is a tempta¬
tion to ask science to choose between opinions and beliefs, which
neutralize one another. The question of when human life begins
requires the essential aid of different forms of knowledge. Here we
become involved in the juncture between science and religion,
which needs to be carefully explored.
Codes of Perinatal Ethics: An International Perspective 45
Joseph G. Schenker
The public is interested in how and to whom health care is provided.
This public awareness has led to a growing need for the medical pro¬
fession to be fully aware of the public s views on issues of human
rights, social structure, and health care policies, and how these affect
the physician s daily practice. Many believe that the physician
should not be left alone to make decisions of an ethical nature. This
has prompted the development of ethics committees in institutions
and by governments and international bodies. This article pro¬
vides an overview of hospital ethics committees, national ethics
committees, and international ethics committees, with a focus on the
International Federation of Obstetricians and Gynecologists (FIGO)
ethics committee and the documents it has produced.
Preimplantation Diagnosis 67
Lawrence J. Nelson
The ethics of preimplantation genetic diagnosis (PGD) mainly per¬
tains to its marketing, the moral status of embryos and the ethics
of discarding them, and the tests that clinicians do and do not offer
to patients. Marketing information should be accurate, complete,
and nonself serving. Although human embryos deserve some
moral respect, it is ethical to discard embryos for good reason and
with the consent of the gamete sources. Discarding embryos with
disabling disorders does not disrespect existing disabled persons
or encourage discrimination. Clinicians must use their conscience
in deciding which tests to offer patients as part of PGD.
Ethical Dimensions of Genetic Counseling 81
Akos Csaba and Zoltan Papp
The decision to follow the advice of genetic counseling should be
made by the couple. The counselor should inform the couple pre¬
cisely and offer different types of screening and diagnostic methods.
For free choice to be preserved, it is crucial that the decision made by
the patients in no way influences further pregnancy care, and that the
physician continues to provide the broadest range of services possi¬
ble. The individual s and the family s personal rights must not suffer
damage, and genetic information may be made public only with
their consent. In the near future we will have to face very complex
and difficult ethical and moral challenges.
vi CONTENTS
Ethical Dimensions of Nuchal Translucency Screening 95
Stephen T. Chasen and Daniel W. Skupski
First trimester screening for Nuchal Translucency (NT), when con¬
ducted according to accepted standards of quality, is a reliable diag¬
nostic screen. There is no compelling beneficence based argument
opposed to offering it, and offering it is an important autonomy
enhancing strategy. Screening should be offered only in centers
where high quality is available. In our view, the results of ongoing
trials will enhance this position.
Selective Reduction 103
Mark I. Evans, Eric L. Krivchenia, Shari E. Gelber,
and Ronald J. Wapner
Multifetal pregnancy reduction (MFPR) is a clinical procedure that
dates back to the mid 1980s, when a small number of centers in
the United States and Europe attempted to ameliorate the usual
adverse sequelae of multifetal pregnancies by selectively termi¬
nating or reducing the number of fetuses to a more manageable
number. We hope that MFPR will become obsolete as better con¬
trol of ovulation agents and assisted reproductive technologies
make multifetal pregnancies uncommon.
Fetal Anomalies: Ethical and Legal Considerations in
Screening, Detection, and Management 113
Carson Strong
The obstetrician has a duty, based on the ethical principle of benefi¬
cence, to provide emotional support to the pregnant woman who
learns that her fetus has an anomaly. There also is a duty, arising from
the principle of autonomy, to help the pregnant woman make
informed decisions about care that are based on her values and goals.
The determination of viability, for the purpose of abortion decisions,
is based on US Supreme Court statements on the definition of viabil¬
ity. After viability, the physician should recommend aggressive man¬
agement or nonaggressive management, depending on an analysis
of the risks and benefits to the pregnant woman and fetus in the par¬
ticular case. The physician s decisions about management should
respect the informed considered wishes of the mentally competent
pregnant woman.
Refusal of Treatment During Pregnancy 127
Sarah F. Adams, Mary B. Mahowald, and Janet Gallagher
A survey of maternal fetal medicine fellowship directors in the 1980s
found that many supported coercive treatment of pregnant women
for the sake of their potential children. To examine whether legal,
social, and medical developments since then have led to changes in
practice or attitudes about this issue, we surveyed current directors of
CONTENTS vii
maternal fetal medicine fellowship programs. Our data show that the
number of requests for court orders in such cases has declined, but
some practioners and judges still support them. In this article we offer
an update on pertinent legal rulings, describe the method and results
of our study, and discuss ethical aspects of the issue.
Maternal Fetal Research and Human Research Protections Policy 141
Angelique M. Reitsma and Jonathan D. Moreno
Maternal fetal surgery is innovative surgery that has received
attention from professionals and the lay public alike, leading to the
initiation of formal clinical trials to establish its efficacy. As with all
experimental therapy, protection of human subjects is a challenging
and important issue. Trials studying maternal fetal surgery are dis¬
cussed in light of the new federal regulations protecting pregnant
women and fetuses in research.
Maternal Fetal Surgery for Treatment of Myelomeningocele 155
Anne Drapkin Lyerly and Mary B. Mahowald
The surgical correction of nonlethal fetal anomalies such as
myelomeningocele raises important ethical issues relevant to peri
natology practice. Questions include who is the patient (ie, the
woman, the fetus, or both) and how, if at all, is it possible to do
ethically appropriate research on this nonvalidated procedure. We
examine these issues, discuss how the conceptual separation of the
woman and fetus distorts ethical and policy analyses, and conclude
with a suggestion for avoiding the ethical problems associated with
the evaluation and use of maternal fetal surgery.
Contemporary View of the Effect of Managed Care on the
Ethics in Perinatal Medicine 167
Peter A. Schwartz
Managed care has significantly altered the patient physician relation¬
ship, and these changes have created new ethical challenges within
that relationship. The physician s obligation of beneficence has been
challenged by his contract with managed care. Physicians have faced
increasing apparent and real conflicts of interest. The patient s right of
choice has been challenged by her contract with managed care.
Within perinatal medicine, those challenges have affected mode of
delivery, use of technology, length of stay, and pharmaceutical
choices. Additional challenges and opportunities to enhance quality
of care lie ahead in the evolution of the health care system.
Index 181
viii CONTENTS
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| spellingShingle | Ethics in perinatal medicine Clinics in perinatology Ethische aspecten gtt Perinatale geneeskunde gtt Ethik Ethics, Medical Fetal Research ethics Fetus Research Moral and ethical aspects Fetus Surgery Moral and ethical aspects Fetus surgery Medical ethics Perinatology Moral and ethical aspects Perinatology ethics Prenatal Care ethics Prenatal care Moral and ethical aspects Perinatale Medizin (DE-588)4045170-7 gnd Medizinische Ethik (DE-588)4074672-0 gnd |
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| title | Ethics in perinatal medicine |
| title_auth | Ethics in perinatal medicine |
| title_exact_search | Ethics in perinatal medicine |
| title_full | Ethics in perinatal medicine Frank A. Chervenak ..., guest eds. |
| title_fullStr | Ethics in perinatal medicine Frank A. Chervenak ..., guest eds. |
| title_full_unstemmed | Ethics in perinatal medicine Frank A. Chervenak ..., guest eds. |
| title_short | Ethics in perinatal medicine |
| title_sort | ethics in perinatal medicine |
| topic | Ethische aspecten gtt Perinatale geneeskunde gtt Ethik Ethics, Medical Fetal Research ethics Fetus Research Moral and ethical aspects Fetus Surgery Moral and ethical aspects Fetus surgery Medical ethics Perinatology Moral and ethical aspects Perinatology ethics Prenatal Care ethics Prenatal care Moral and ethical aspects Perinatale Medizin (DE-588)4045170-7 gnd Medizinische Ethik (DE-588)4074672-0 gnd |
| topic_facet | Ethische aspecten Perinatale geneeskunde Ethik Ethics, Medical Fetal Research ethics Fetus Research Moral and ethical aspects Fetus Surgery Moral and ethical aspects Fetus surgery Medical ethics Perinatology Moral and ethical aspects Perinatology ethics Prenatal Care ethics Prenatal care Moral and ethical aspects Perinatale Medizin Medizinische Ethik Aufsatzsammlung |
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