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El. knyga: Professional Responsibility Model of Perinatal Ethics

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This book provides the first clinically comprehensive and practical approach to ethical challenges in perinatal medicine. The first chapter introduces and explains the professional responsibility model of perinatal ethics. The professional responsibility model is based on the medical ethics of two major physician-ethics in the history of Western medical ethics, Dr. John Gregory (1724-1773) of Scotland and Dr. Thomas Percival (1740-1804) of England. The professional responsibility model is used to articulate the ethical concept of the fetus as a patient and to operationalize the ethical principles of beneficence and respect for autonomy. The book provides practical guidance for clinical judgment and decision making with patients about the responsible clinical management of the wide range of issues encountered by perinatologists in clinical practice and research. Topics included: periviability; feticide; intrapartum management; maternal-fetal conflict; innovation for fetal benefit; research for fetal benefit; non-aggressive obstetric management; managing the transition from pregnancy to birth; destructive procedures such as cephalocentesis; critical care for the pregnant patient; home birth; patient-choice cesarean delivery; neonatal care as a trial of management; and setting limits on neonatal care on the basis of clinical judgments of futility.
Preface vii
1 The professional responsibility model of perinatal ethics
1(18)
1.1 Introduction
1(1)
1.2 Ethics, medical ethics, and perinatal ethics
1(10)
1.2.1 Ethics
1(1)
1.2.2 Medical ethics
2(4)
1.2.3 Perinatal ethics
6(5)
1.3 The professional responsibility model of perinatal ethics
11(4)
1.3.1 Rights-based reductionism
12(1)
1.3.2 The ethical concept of medicine as a profession
13(2)
1.4 Conclusion
15(1)
1.5 References
15(1)
1.6 Summary points
16(3)
2 Induced abortion and feticide
19(10)
2.1 Introduction
19(1)
2.2 Terminology
19(1)
2.3 Offering induced during abortion or feticide
19(3)
2.3.1 After viability
19(1)
2.3.2 Before viability
20(2)
2.4 Recommending induced abortion or feticide
22(2)
2.5 Performing induced abortion or feticide
24(1)
2.6 Referring for induced abortion or feticide
25(1)
2.7 Conclusion
26(1)
2.8 References
26(1)
2.9 Summary points
27(2)
3 Periviability
29(8)
3.1 Introduction
29(1)
3.2 Clinical outcomes data
29(1)
3.3 Induced abortion
30(1)
3.4 Obstetric and neonatal dimensions
31(3)
3.5 Burdens on parents and society
34(1)
3.6 Conclusion
34(1)
3.7 References
34(2)
3.8 Summary points
36(1)
4 Intrapartum management
37(18)
4.1 Introduction
37(1)
4.2 A preventive ethics approach to cesarean delivery
37(2)
4.3 Recommendations regarding mode of delivery
39(5)
4.3.1 Recommending cesarean delivery
39(1)
4.3.2 Offering both cesarean delivery and vaginal delivery
39(1)
4.3.3 Recommending vaginal delivery
40(1)
4.3.4 Responding to requests for non-indicated cesarean delivery
41(3)
4.4 The role of destructive procedures
44(4)
4.4.1 Cephalocentesis for intrapartum management of hydrocephalus
44(1)
4.4.2 Isolated fetal hydrocephalus
45(1)
4.4.3 Hydrocephalus with severe associated abnormalities
46(1)
4.4.4 Hydrocephalus with other associated anomalies
47(1)
4.5 Non-aggressive obstetric management
48(3)
4.5.1 Aggressive and non-aggressive obstetric management defined
49(1)
4.5.2 When beneficence-based obligations to the fetal patient cease to exist
49(1)
4.5.3 When beneficence-based obligations to the fetal patient become minimal
50(1)
4.5.4 Counseling the pregnant woman in the informed consent process for non-aggressive obstetric management
50(1)
4.6 Conclusion
51(1)
4.7 References
51(2)
4.8 Summary Points
53(2)
5 Planned home birth
55(12)
5.1 Introduction
55(1)
5.2 Critical appraisal of the assumption that planned home birth is compatible with professional responsibility
55(3)
5.3 Planned home birth attendants are not acting in a professional capacity
58(1)
5.4 Professional responsibility and hospital birth
59(1)
5.5 Respect for the pregnant women's rights
60(1)
5.6 Professionally appropriate responses
61(2)
5.6.1 What should perinatologists do to address the root cause of the recrudescence of planned home birth?
61(1)
5.6.2 How should perinatologists respond when a woman raises the topic of planned home birth?
62(1)
5.6.3 How should perinatologists respond to a woman's request for the perinatologist to participate in planned home birth?
62(1)
5.6.4 How should perinatologists respond when a patient is received on emergency transport from a planned home birth?
62(1)
5.6.5 Should obstetricians participate in or refer patients to a randomized controlled clinical trial of planned home vs. planned hospital birth?
62(1)
5.7 Conclusion
63(1)
5.8 References
63(2)
5.9 Summary Points
65(2)
6 Pregnant patients with mental disorders
67(12)
6.1 Introduction
67(1)
6.2 Clinical considerations
67(1)
6.3 Responsibly managing the decision-making process
68(6)
6.3.1 Chronically and variably impaired autonomy
69(1)
6.3.2 Assisted decision making
70(1)
6.3.3 Surrogate decision making
71(1)
6.3.4 Strategies for dealing with strong feelings that these patients can evoke
72(2)
6.4 Clinical applications
74(2)
6.4.1 The decision whether to continue a previable pregnancy to viability and thus to term
74(1)
6.4.2 Intrapartum management
74(1)
6.4.3 Decisions about child-rearing and adoption
75(1)
6.5 Conclusion
76(1)
6.6 References
76(2)
6.7 Summary points
78(1)
7 Neonatal management
79(18)
7.1 Introduction
79(1)
7.2 Neonatal medical ethics: Delivery makes a difference
79(1)
7.3 Justified limits on resuscitation and neonatal critical care
80(3)
7.4 The perinatologist's professional responsibility to reject infanticide: The Groningen Protocol is clinically unnecessary, unscientific, and unprofessional
83(9)
7.4.1 Is The Groningen Protocol clinically necessary?
84(1)
7.4.2 Is the Groningen Protocol scientific?
85(2)
7.4.3 Is the Groningen Protocol professional?
87(5)
7.5 Conclusion
92(1)
7.6 References
93(1)
7.7 Summary points
94(3)
8 Perinatal innovation and research
97(14)
8.1 Introduction
97(1)
8.2 Innovation and research
97(1)
8.3 Current research regulations
98(3)
8.4 The central ethical challenge
101(2)
8.5 Research designed to improve the health of pregnant women
103(1)
8.6 Research designed to improve medical and surgical management of the fetal patient
104(3)
8.7 Responsibly managing the transition from investigation to clinical practice
107(1)
8.8 Conclusion
108(1)
8.9 References
108(2)
8.10 Summary points
110(1)
9 Women and children first: Advocacy in perinatal medicine
111(10)
9.1 Introduction
111(1)
9.2 "Women and children first"
111(1)
9.3 Justice-based professional responsibility
112(1)
9.4 Challenges to justice in the allocation of healthcare resources to women and children
113(5)
9.4.1 Challenges to substantive justice
113(3)
9.4.2 Challenges to procedural justice
116(2)
9.5 Conclusion
118(1)
9.6 References
118(1)
9.7 Summary points
119(2)
10 Critically appraising the literature of perinatal ethics
121(6)
10.1 Introduction
121(1)
10.2 Four-step approach
121(4)
10.2.1 Step 1: Does the argument address a focused ethics question?
121(1)
10.2.2 Step 2: Are the results of the argument valid?
122(2)
10.2.3 Step 3: What are the results of the argument?
124(1)
10.2.4 Step 4: How should I apply the results in clinical practice, research, or advocacy?
124(1)
10.3 Conclusion
125(1)
10.4 References
125(1)
10.5 Summary points
125(2)
11 Acknowledgements
127(2)
Index 129
Frank A. Chervenak, Weill Cornell Medical College, New York, USA; Laurence B. McCullough, Baylor College of Medicine, Houston, USA.
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