**Bioethics in Obstetrics**

#### Joseph Ifeanyi Brian-D. Adinma

*Department of Obstetrics and Gynaecology Nnamdi Azikiwe University and Teaching Hospital, Nnewi, Nigeria* 

#### **1. Introduction**

296 From Preconception to Postpartum

Xu H, Perez-Cuevas R, Xiong X, Reyes H, Roy C, Julien P, *et al*. (2010). An international trial

Young B., Levine R. & Karumanchi A. (2010). Pathogenesis of preeclampsia. *Annu Rev* 

Zanardo V., Savio V., Sabrina G., Franzoi M., Zerbinati P., Fadin M., Tognin G., Tormene D.,

Vol. 202, No. 3, pp. 239.e1-239.e10, ISSN 0002-9378

*Coagul Fibrinolysi*s Vol. 16, No. 3, pp. 177-81, ISSN 0957-5235

*Pathol*, Vol. 5, pp. 173-92, ISSN 1553-4006

of antioxidants in the prevention of preeclampsia (INTAPP). *Am J Obstet Gynecol*,

Pagnan A. & Simioni P. (2005). The effect of pre-eclampsia on the levels of coagulation and fibrinolysis factors in umbilical cord blood of newborns. *Blood* 

> Obstetrics has been defined as the branch of medicine concerned with child birth. This simplistic definition may not entirely represent the plethora of events, many challenging, others contentious that are usually associated with the developmental processes that culminate in the birth of the child. They can therefore be only but a few aspect of clinical practice that are likely to elicit as much bioethical considerations as obstetrics practice. Bioethical questions arise in virtually all aspects of pregnancy and child birth starting from ethical issues involved in genetics and embryo research through the process of assisted reproduction, surrogacy, abortion, the process of normal and abnormal pregnancies, safe motherhood and neonatal care. Cook et al have observed the emerging significant of bio-ethics over the last half a century, at both professional and scholarly levels, and have further highlighted the input of multiple discipline – biology, philosophy, healthcare service, medicine, law, nursing and religious studies in the structuring of modern bioethics. This perhaps has been most profoundly expressed in obstetrics care, and indeed reproductive health as a whole. The medical profession in several cultures has an inherent responsibility to conduct its activities guided by the highest ethical standard. Reproductive healthcare practitioners in particular inevitably face ethical and bioethical challenges, some of which constitute a conflict between the old and new, requiring resolution, for example, the process of super-ovulation with higher multiple pregnancies, associated with assisted reproduction may require the ethicallyquestionable process of selective reduction foeticide in order to ensure the survival of one or two foetuses and facilitate the success of the procedure. Health professionals looking after woman are more compelled to observe strict ethical principles because they work in areas of women's body that are private and of particular psycho-sexual sensitivity (Ezeani, 2003). The decision to oblige to treatment request, obstetrics care inclusive requires that the reproductive healthcare practitioner appraises and appreciates his or her personal ethical stand-point which is then related to his duty to address the well being of his patients and also the overall character and conscience of the community. The need to include bioethics in the training curriculum of residents in obstetrics and gynaecology has become compelling and over the past two decades been increasingly highlighted (Elkins et al, 1986; Royal College of Physicians and Surgeons of Canada, 1997). As clearly stated by Mckneally and Singer (2001) "Enhancing Clinicians" knowledge and skills in resolving ethical quandaries can increase their ability to deal with issues that cause moral distress and

Bioethics in Obstetrics 299

The thinking and end result of bioethical considerations are directed along various set-lines, constituting different bioethical orientations. The ancient Greek value system and philosophy considered to be the origin of bioethics together with the input of various religions notably Christianity and Islam over the years represent the historical orientation of

Duty based or deontological bioethical orientation is related to natural laws and reason, distinguishing vice from virtue as an indivisible accompaniment of any action or intention. The Catholic Church is a well known proponent of duty based bioethics and this is evident from the church's stand for instance against the use of condom for prevention of pregnancy or sexually transmitted infection or against artificial forms of contraception, while supporting natural family planning. St. Thomas Aquinas in the 13th century incorporated some natural laws developed and proposed by Aristotle into the doctrine of the Roman Catholic Church. Duty based bioethical orientation is believed to be absolutist and often unbending to the relativity and diversity that characterize ethical considerations. This may have serious implications to reproductive health in general,

Utilitarian or consequentialist bioethical orientation recognizes man's moral responsibility for his or her bioethical choices. Whatever promotes the well-being or happiness of man is considered to be good while whatever causes harm or unhappiness to man is bad. It recognizes man as an important end in himself rather than being a means to an end of whatever form. For example, a woman with an unwanted pregnancy, desirous of termination of the pregnancy should be assisted with safe and unencumbered induced abortion since this may promote her psychological and social well

Feminist bioethical orientation basically aims at incorporating women's social experiences, thinking and behavior into the value system of healthcare and clinical practice. It is also known as ethics of care or connectedness, and constitutes a reaction to the exclusion of women from historical sources of moral authority such as the clergy, top echelons of the military or legislature and other similar position exclusively "restricted" on the basis of sex

Apart from these bioethical orientations considered to be key towards effective bioethical considerations, there are a few others that have become recognized which include the

Virtue – tenets to which biomedical institutions and practitioners should adhere to, such as kindness, trustworthiness, discernment, and integrity, all of which conform to the ethical

Communitarianism – bioethical orientation that advances and promotes the good of the

Casuistry - proponents of this orientation subscribe to the resolution of issues on the basis of

**3. Bioethical orientations** 

often replete with bioethical challenges.

bioethics.

being.

or gender.

following:

community.

ideals of Hippocrates.

their merit rather than on a resort to universal rules.

and thus enable better team and institutional performance in caring for patients. The Royal College of Physicians and Surgeons of Canada had since the late 1990 insisted that the teaching of bioethics be made a requirement for accreditation of any residency training programme. In furtherance to this, Council on Resident Education in Obstetrics and Gynaecology stated the objectives that residents must demonstrate an understanding of basic ethical concepts and their application to the issues and decisions based in the practice of obstetrics and gynaecology (Royal College of Physicians and Surgeons of Canada, 1997).

This chapter defines bioethics together with a brief account of its historical origin particularly in relation to the development of principles of modern bioethics. It also describes the fundamentals of bioethics – notably bioethical orientation, principles and analytical levels. It further highlights research ethics and reviews key obstetrics issues requiring bio-ethical consideration.
