Midterm 2 Readings

Question 1

Explain the ethical tensions between autonomy, beneficence and nonmaleficence:

Answer 1

Autonomy describes a woman’s right to security of person

Beneficence: “Do what is best”
nonmaleficence: “Do no harm”

Nurses apply the two concepts to make the best possible medical recommendations. When a woman exercises her autonomy to refuse recommended care, it leave nurses in a strange situation. They feel as if they are likely to have to follow through with potentially harmful procedures.

Question 2

Explain how dichotic and nuanced thinking are important in obstetrics:

Answer 2

Medical decisions are not black or white. There are many “it depends” situations that go into decisions such as C-Sections vs standard births. Benefit to harm ratios can impact how strong a recommendation from a doctor is. When harm and benefit are equal, doctors tend to let the decision be made by the parent.

Question 3

How does the subjectivity of risk to benefit ratios come into play in obstetrics?

Answer 3

EX: Space shuttle program: 2% risk of dying, not having a C-section: 1/2000 chance of composite risk to the fetus

once again why allowing freedom of autonomy is important

Question 4

Briefly explain ways in which coercion can be detrimental to pregnant women:

Answer 4

1. It negates consent, which can leave the doctor susceptible to lawsuits and being legally liable for complications
2. May lead to women delivering unattended at home, or pressuring their midwives to attend risky homebirths
3. Practitioners are not liable for legal complications, there is no risk to the doctor to allow the woman give or not give consent

Question 5

How can nonmaleficence comply with autonomy?

Answer 5

While a practitioner should refuse to perform an intervention that they believe to be unsafe, the provision of care during childbirth is not an intervention. The doctor may neither force her to have surgery nor abandon her.

Question 6

What should a clinician do when faced with a woman who decides to accept an additional risk?

Answer 6

1. Clearly recommend against the “risky” course of action
2. Have a second practitioner counsel the patient, if possible.
3. Document informed refusal, using a preprinted form if desired (see Appendix).
4. Reassure her that she will continue to receive courteous, professional care.

Question 7

How does detached care work and why is it important for doctors to adopt this in obstetrics?

Answer 7

Taking refusals personally can strain the patient-clinician relationship and cause problems.

It is a doctor’s job to understand that a woman’s refusal of care can come from many factors and is not usually personal to the doctor.

it is important that the doctor reassures the woman that she will be cared for even after refusal

Question 8

What is extremely important when it comes to refusal of care (legally)

Answer 8

That it is clear the woman is informed. It is recommended that a second consultant counsels the patient and makes absolutely sure that she is informed.

It must be clear to everyone that the doctor is respecting her right to choose and is not endorsing her decision.

Question 10

Briefly explain why it is important that the right to “security of person” is important, in and outside the context of the course:

Answer 10

Measures of risk vs benefit are subjective. People may have religious beliefs that prevent them from accepting certain treatment (EX: Jehovah’s witnesses and blood transfusions). Fetuses are not considered legal persons, therefore the woman has every right to make decisions without the need to consider another legal person.