**6. Research ethical review**

Ethical considerations are perhaps more profoundly manifest in research than in most other aspect of medicine. Medical research especially those involved with human embryo and stem cell often bring to bear the demands and challenges posed by different bioethical orientations. Deontological bioethicists for their firm adherence to an orientation of natural laws and reasons are unlikely for instance to condone research targeted at exposing life threatening foetal abnormalities that would ordinarily require termination, in a pregnant subject. In the same vein, consequentialist and feminist bioethicists will employ macroethical reasoning to justify the conduct of research on a few human embryo and stem cells for the purpose of obtaining information that will lead to the development of therapy that will benefit many more sick patient (Stephens and Brynner, 2001). Ethical conflicts arise

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women, and also incorporate same into the curriculum of medical education; and advocacy into two key areas of sexual and reproductive right failings of women in each country. The project was conducted in each of the countries by a multidisciplinary steering committee under the auspices of the national FIGO – member society. Ethical guideline developed by each of the participating countries were eventually employed in the development of FIGO professional and ethical responsibility guideline concerning sexual and reproductive rights, at the XVII FIGO World Congress in Santiago Chile in 2006 (Adinma, 2003; FIGO, 2004).

a. **Professional Competence** – which enjoins the health professional to uphold the highest standard of professional practice in the care of his patient, avoid inappropriate relationship with patients or his family members, carry out prompt referral of patients when the expertise to care is lacking or in situation of conscientious objection to care of the patient. The health professional is also obligated to avoid ethical and human right violation in the care of their patient, develop appropriate interpersonal relationship with their patients and others while upholding the highest standard of integrity with colleagues and patients. They should also continuously update their professional

b. **Women's Autonomy and Confidentiality** - which obligates health professionals to inform and educate their patient to facilitate informed consent, ensure their right to privacy and confidentiality and avoid all forms of discrimination. The health professionals will also have an obligation to guide adolescents towards making ethics

c. **Responsibility to the Community** - which obligates health professionals to advocate for the right of their community members to information, education and means to make appropriate sexual and reproductive rights decision, advocate for the provision of resources and care that will enable women benefit from scientific progress and also promote reproductive health education of community members that will enable them participate in dialogue on health policy decisions concerning them. They should also discourage the patronage of quacks by community members, encourage traditional healers to refer patient, and show compassion to patients with medical emergencies especially with respect to payment of deposit and during industrial actions (FIGO, 2006;

An unbalance relationship exists between the medical practitioner and his female patient borne out of differences between them in social, cultural and economic circumstances together with inequality in knowledge of medicine. The woman seeking health care is therefore posited on a pedestal of vulnerability. The medical practitioner should address this vulnerability by giving clear information on every available treatment option that will enable the patient decide on her appropriate treatment choice. The woman's autonomy is thereby respected. This situation is no less appropriate to the obstetrics patient than is considered to other patient and this respect for her right to informed decision and consent should be sustained throughout the duration of her pregnancy. Every obstetrics patient has the right to the highest standard of obstetrics care and benefit of scientific progress and should under no circumstances be allowed to go through unnecessary or avoidable pain

These professional ethical guidelines are contained in three basic groupings.

knowledge through continuing medical education.

based reproductive health decisions.

Adinma, 2003; FIGO, 2004).

**8. Obstetrics care** 

as to the propriety of employing human subject to carry out scientific studies to reveal vital information that will contribute to the successful management of a vast number of patients as was the case with the Tuskegee Syphilis Research which not only unveiled the long term manifestations of syphilis but also heralded the genesis of the developmental framework for the principles of modern bioethics from the Belmont Report. However it has been established that the well-being of human subject should be given priority consideration to the interest of science and the society (WMA, 2000).

It became necessary at a point to develop an acceptable course in bio-medical research involving not only humans but also animals and the environment. Two landmark guidelines emerged over the years concerning the conduct of research on human subjects – the Nuremberg Code of Ethics developed in 1947 following the trial of 23 German Physicians and Administrators for inhuman experimentations on human subjects during the 2nd world war and the Helsinki Declaration of the 18th General Assembly of the World Medical Association which developed recommendations and later ethical principles for medical research involving human subjects (WMA, 2008).

Helsinki consists of 35 principles, the first 30 of which relate to medical research, while the last 5 concern clinical practice. Between 1964 and 2008 Helsinki has been revised 9 times, the 9th of which was at the 59th General Assembly of the World Medical Association in Seoul South Korea in 2008. Helsinki Declaration recognizes the safety, autonomy, confidentiality, and the dignity of human subject in research. It also recognizes that potential benefits that should accrue to research subjects, and that research should be discontinued if the risk outweighs its benefits. Helsinki Declaration further requires that the protocol of the subject under study be submitted in advance to a Research Ethics Committee that is independent of the investigator or sponsor of the study, for scrutiny, consideration, comments, and ultimate approval or rejection (WMA, 2008). Ethical committee members are multidisciplinary and include not only medical professionals but also a lawyer, a clergy, an ethicists and other notable member of the community all of whom should be familiar with scientific basis of proposals together with the laws and regulations of the country in which the research experiment is performed.
