Reproductive Ethics Flashcards
When working with a pregnant patient who has refused medically recommended treatment, the following principles should be considered:
- Reliability and validity of evidence base
- Severity of prospective outcome
- Degree of burden or risk on patient
- Extent to which patient understands risks involved for herself and her fetus
- Degree of urgency that the case presents
It is not ethically defensible to invoke ___ as a justification to attempt to persuade a patient into accepting care she does not desire.
It is not ethically defensible to invoke conscience as a justification to attempt to persuade a patient into accepting care she does not desire.
Any fetal intervention has . . .
. . . implications for the pregnant woman’s health and necessarily her bodily integrity, and therefore cannot be performed without her explicit informed consent.
When the pregnant woman and fetus are conceptualized as separate patients, . . .
. . . the medical interests, health needs, and rights of the woman may come secondary to those of the fetus at times.
The OBGYN College officially endorsed ethical approach to pregnant woman-fetal care is . . .
that the primary duty of the physician is to the pregnant woman, not to her fetus
The physician has beneficence-based motivation to care for the fetus, but a beneficence-based obligation to care for the pregnant woman.
Questions of how to care for a fetus cannot be ___.
Questions of how to care for a fetus cannot be a simple cost-benefit analysis for the fetus and the woman.
They must respsect individual values and the pregnant woman’s autonomy and control over her own body.
Directive counciling
Patient counseling in which the OBGYN physician plays an active role in the patient’s decision making by offering guidance, advice, recommendations, or some mixture thereof.
This definition is used to make in juxtaposition to coercion
An OBGYN physician may not utilize arguments involving ____ to advise a pregnant woman, as this falls into the realm of coercion.
An OBGYN physician may not utilize arguments involving terms of duress or references to courts or child protective services to advise a pregnant woman, as this falls into the realm of coercion.
The OBGYN should affirm . . .
. . . the importance of a pregnant woman’s assessment of her relational interests (personal, familial, social, community).
The OBGYN world is frought with ___.
The OBGYN world is frought with prognostic uncertainty.
Things a physician must keep in mind when discussing reproductive ethics with a patient
- Limitations of the patient’s understanding
- Prognostic uncertainty
- Different cultural or social values
- Language barriers
- Power dynamics
When a pregnant woman refuses medical treatment, the physician must. . .
When a pregnant woman refuses medical treatment, the physician must document this refusal in the medical record, including all aspects of informed dissent, and the patient’s reason for refusal.
At all costs, OBGYN physicians should avoid ___.
At all costs, OBGYN physicians should avoid court orders for interventions.
RESPECT communication model
- Rapport
- Empathy
- Support
- Partnership
- Explanations
- Cultural competence
- Trust
Presumptive consent
Used as a defense for critically needed emergency care, often when the patient is anesthetised mid-procedure. Only applies when the patient has not indicated preference beforehand.
virtue-based approach in OBGYN ethics
Would focus on the courses of action to which different virtues would and should dispose the obstetrician–gynecologist. For instance, which course of action would follow from compassion? From respectfulness? And so forth.
ethic of care in OBGYN
Would concentrate on the implications of the virtue of caring in the obstetrician–gynecologist’s special relationship with the pregnant women and with the fetus.
Would resist viewing the relationship between the pregnant woman and her fetus as adversarial, though their interests are not always aligned.
If, however, a real conflict does exist, the obstetrician–gynecologist should resist feeling the need to take one side or the other. Instead, he or she should seek a solution in identifying and balancing his or her duties in these special relationships
feminist ethics approach
Would attend to the social structures and factors that limit and control the pregnant woman’s options and decisions in this situation and would seek to alter any that can be changed
case-based approach
Would consider whether there are any relevantly similar cases that constitute precedents for the current one
The abortion debate goes back to. . .
. . . Hippocrates and Aristotle.
Hippocrates was anti-abortion, Aristotle was pro-choice.
The central question in abortion ethics
Is the fetus (an incompetent) person with rights that impose correlative obligations on others?
Conscientious objection
The refusal to perform or participate in an activity associated with a professional role due to a conflicting moral or religious conviction
Physicians and other health care professionals have long had the right to . . .
Physicians and other health care professionals have long had the right to opt out of participating in abortion, aid-in-dying, and other legally authorized health services.
Limits of conscientious objection
- Degree to which a refusal constitutes an imposition on patients who do not share the objector’s beliefs
- Impact such a refusal might have on well-being as the patient perceives it
- The scientific integrity of the facts supporting the objector’s claim
- Potential for discrimination
In an emergency in which referral is not possible or might negatively affect a patient’s physical or mental health, . . .
In an emergency in which referral is not possible or might negatively affect a patient’s physical or mental health, providers have an obligation to provide medically indicated and requested care regardless of the provider’s personal moral objections
In resource-poor areas, . . .
In resource-poor areas, access to safe and legal reproductive services should be maintained. Conscientious refusals that undermine access should raise significant caution.
