What is obstetric ethics?

Abstract

Ethics is the study of morality that encompasses right or wrong behavior. The ethical principles of beneficence for autonomy are cornerstones of medical ethics. The physician can identify those clinical strategies that will result in the protection and promotion of the health related interests of the patient. The ethical principle of beneficence from the time of Hippocrates has dictated seeking the greatest balance of good over harm for patients. Respect for autonomy enters clinical practice by the informed-consent process: disclosure by the physician to the patient of adequate information about the patient's condition and its management and a decision by the patient to authorize or refuse clinical management. Beneficence-based obligation to the fetus begins with the recognition that being a patient does not require independent moral status. Viability exists as a function of biomedical and technologic capacities without worldwide uniform gestational age. In the US, it occurs at approximately 24 weeks' gestational age. Directive counseling for fetal benefit is justified ethically based on the fetus as a patient. In clinical practice it involves recommending 1) against termination of pregnancy, 2) against nonaggressive management, or 3) for aggressive management (interventions such as fetal surveillance, tocolysis, Caesarean delivery). Directive counseling for fetal benefit must consider the severity of fetal anomalies, extreme prematurity, and obligations to the pregnant woman. Inquiry into the various issues in obstetric ethics entails a basic distinction between descriptive and normative ethics. The criteria is normative obstetric ethics require clarity, consistency, coherence, clinical applicability, clinical adequacy, and completeness. Pitfalls to be avoided in law, religion, professional consensus, uses of authority, and philosophy that contribute to normative obstetric ethics are also considered.