**7. Obstetrics issues eliciting ethical attention**

The provision of ethical care that respects the sexual and reproductive rights of women is considered fundamental and therefore implicit on professionalism in healthcare of women. The International Federation of Gynaecology and Obstetrics (FIGO) has over the years provided leadership role and direction towards the structuring and promotion of professional ethical standards in women's health and indeed reproductive healthcare as a whole through its committee for the Study of Ethical Aspects of Human Reproduction and Women's Health (FIGO, 2006).

In 2001, FIGO through its Sexual and Reproductive Right Committee carried out a Women's Sexual and Reproductive Right Project, undertaken in six counties:- Nigeria, Ethiopia, India, Pakistan, Sudan and Mexico. This project essentially consisted of advocacy and sensitization of obstetrics and gynaecology professionals on areas of women's sexual and reproductive right infringement and the need to uphold, protect and promote these rights; the development of a human right based code of ethics to guide health professionals caring for

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

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

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

The provision of ethical care that respects the sexual and reproductive rights of women is considered fundamental and therefore implicit on professionalism in healthcare of women. The International Federation of Gynaecology and Obstetrics (FIGO) has over the years provided leadership role and direction towards the structuring and promotion of professional ethical standards in women's health and indeed reproductive healthcare as a whole through its committee for the Study of Ethical Aspects of Human Reproduction and

In 2001, FIGO through its Sexual and Reproductive Right Committee carried out a Women's Sexual and Reproductive Right Project, undertaken in six counties:- Nigeria, Ethiopia, India, Pakistan, Sudan and Mexico. This project essentially consisted of advocacy and sensitization of obstetrics and gynaecology professionals on areas of women's sexual and reproductive right infringement and the need to uphold, protect and promote these rights; the development of a human right based code of ethics to guide health professionals caring for

the interest of science and the society (WMA, 2000).

research involving human subjects (WMA, 2008).

**7. Obstetrics issues eliciting ethical attention** 

experiment is performed.

Women's Health (FIGO, 2006).

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). These professional ethical guidelines are contained in three basic groupings.


### **8. Obstetrics care**

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

Bioethics in Obstetrics 305

offspring syndrome and immune system failure. It is generally believed to be unsafe and therefore ethically not permissible for use in human reproduction. However, subject to strict observation of ethical guideline, research on human embryo stem cells from Somatic Cell Nuclear Transfer to produce various cell lines for the purpose of treatment of diseases is

Apart from the human embryo, stem cells can be obtained from cord blood, the foetus or adults. It can also be obtained from supernumerary embryos at the blastocyt state, in IVF cycles and embryos created de novo from donated gametes. Stem cell studies may be useful in the treatment of many diseases and also in the improvement of the management of infertility. Ethical questions arise in the use of human embryos produced solely for the purpose of research. This can be permitted only if it is not possible to obtain the information sort for, from research on existing supernumerary embryos. Gametes collection for research must be preceded by specific informed consent. Supernumerary embryos from IVF programmes can be used for research only following the consent of the recipients of the resulting embryo. Women particularly the more vulnerable should not be coerced or induced to donate oocyte or embryo for research. A research ethical review is necessary prior to the employment of human embryo for the purpose of research. Donations of gametes and embryos for the purpose of pregnancy and child birth should be on humanitarian basis rather than on commercial consideration, although reasonable compensation for legitimate expenses is allowable. On no account should genetic materials be sold as a profit making venture (Int. J. Gynecol. Obstet, 1994). The donation of genetic materials - egg, sperm or pre – implantation embryo has been used for the treatment of infertility, ovarian failure, severe rhesus iso-immunization, achievement of post menopausal fertility, habitual abortion etc. Such a donation and accompanying child created from it not only have profound ethical implications but are also associated with legal, cultural, moral and religious questions. The child, the recipient couple and the donor all have interest that need to be taking into consideration as well as protected. Different countries have cultural or legal provisions that determine qualification for donation of genetic materials as well as regulate the relationship between the social and the biological parents, the fate of the genetic material (whether for banking or disposal), the protection of the child's interest, and in particular the record keeping rules. The donation of genetic material should be accompanied with informed and written consent of the donor, the recipient and recipient's lawyer. It must be ensured that genetic material donors are normal, healthy and without diseases such as genetic disorders and sexually transmitted infection. Donors of genetic materials should be anonymous and confidentiality should be maintained except when permission for disclosure has been granted. Members of the recipient team should not be donors, nor should genetic materials be obtained from dead persons unless a written consent had been given prior to death. Genetic materials should not be donated for the purpose of extending natural reproductive life span. Donation from one donor should be limited to avoid the danger of consanguinity or incest in the

**11. Human embryo and gamete research, sale and donation** 

permissible.

future.

during the course of the pregnancy. This represents professional commitment to the ethical principles of beneficence, justice and non-maleficence. For example, the giving of episiotomy to a parturient woman to prevent a third degree laceration of the perineum upholds the ethical principles of beneficence, but when the episiotomy is given without prior administration of anesthetic agent, or is repaired without any, or is left un-repaired, this will amount to violation of ethical principles of non – maleficence.

The ethical principles of justice also enjoins that all women should be treated equally and without discrimination in healthcare delivery to them. 
