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Ethics in reproductive health care: a midwifery perspective

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Abstract

Knowledge and technologic advancements have created a myriad of new screening, diagnostic, and treatment options for women of reproductive age. These new options often raise ethical issues as the women, their health care professionals, and society adapt to the benefits while coping with the pressures and burdens these options create. Threats to accomplishing the good that midwifery strives to contribute to health care for the benefit of women are identified from the perspective of the midwife’s instrumental and expressive roles. Suggestions are presented for resolving ethical dilemmas that may occur in the selection and implementation of health care options. A distinction is made between midwifery practice at the microlevel, which achieves the good through direct interaction with the woman, and the institutional macrolevel that promotes accomplishing the good in reproductive health care through policy development and management decisions.

Section snippets

Definition of the good

H. R. Niebuhr (2) describes humans as moral agents who have the choice to form images or visions of the good toward which they direct their actions; specifically within their professional role, the good is defined mutually by the professional reference group. In the United States, a professional group defines its practice based on the needs of society and informs the public of that practice for which it will be responsible. Likewise, one choosing to enter the profession should be held

The good as professed by midwifery

It is customary for each profession to define its own contribution of the good. The good in reproductive health care depends on the blend of each discipline contributing to the collective good.

The ACNM’s official documents clearly communicate the notions of the good encompassed in midwifery 7, 8, 9, 10 as does the Code of Ethics of the International Confederation of Midwives (11). Midwives believe that reproduction represents normal and developmental processes (menstruation, pregnancy, birth,

The impact of new knowledge and technology

With the increasing complexity of reproductive health care that has resulted from the proliferation of new knowledge and technology, midwifery practice has, likewise, become more complex; indeed, it is increasingly difficult to accomplish the good as defined by the profession. New care options have created perplexing choices that often raise ethical issues for women and their families, the health care professions, and other groups in society.

Bioethics: an emerging discipline

Diverse expectations of care, moral pluralism, and the influence of managed care have clearly directed the nation’s attention to the ethical components of health care delivery, especially in light of the increased screening, diagnostic, and treatment options available today. A new discipline, bioethics, focuses on ethics in health care (22) and has applied classical ethical theories and accompanying principles and rules or action guides to health care. Specifically, the principles of respect

Conclusion

The imperative for change in health care requires more than knowledge and technologic advances. Ethical deliberations related to their application are inescapable. The profession of midwifery is challenged to continually assess the relevance of its professed notion of the good to be accomplished for the benefit of women and their families in the context of societal requirements and expectations.

In the existing health care climate, midwifery is being challenged to change in ways that sometimes

Acknowledgements

The author wishes to recognize Lizabeth Andrew for her editorial assistance with the preparation of this manuscript. The author also gratefully acknowledges the collegial relationship since 1988 with Kathleen Kinlaw, associate director, Emory University Center for Ethics in Public Policy and the Professions. Her review of this article is appreciated. An internal research grant of the Nell Hodgson Woodruff School of Nursing, A Pilot Study: Exploring Ethical Dimensions in Prenatal Care Provided

Elizabeth S. Sharp is a BSN graduate of the University of Michigan and the Yale University School of Nursing, Maternal and Newborn Nursing Program. She earned her doctorate in Public Health at the School of Hygiene and Public Health, The Johns Hopkins University. Dr. Sharp is an associate professor in the Department of Gynecology and Obstetrics, School of Medicine; professor in the Nell Hodgson Woodruff School of Nursing; and adjunct professor in the School of Public Health, Emory University,

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