Ethics in obstetrics and gynecology: An overview (2022)


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Volume 75, Issue 1,

1 December 1997

, Pages 91-94


This paper provides an overview of ethical issues in obstetrics and gynecology. We first define two basic ethical principles, beneficence and respect for autonomy. We first apply these principles to gynecologic practice, emphasizing the role of informed consent. We then apply these principles to obstetric practice, utilizing the concept of the fetus as a patient and identifying its clinical implications for directive versus non-directive counseling for fetal benefit.

(Video) Introduction to midwifery professional ethics for all Health science students all over the world!

Section snippets

Ethics in clinical practice

For centuries the obligation to protect and promote the interests of the patient has been the starting point for ethics in clinical practice. This general ethical obligation needs to be made more specific if it is to be clinically useful. To this end, we interpret it in terms of two perspectives on the patient's interests, that of the physician and that of the patient [1].

The ethical principle of beneficence structures medicine's perspective on the interests of the patient because this ethical

Beneficence and respect for autonomy in gynecologic practice

Beneficence obligates the gynecologist to identify all medically reasonable alternatives for the management of the female patient's problem and to assess carefully the benefits and risks of each alternative. The gynecologist may recommend a diagnostic or therapeutic modality on the basis of beneficence. Autonomy requires that the alternatives be presented to the woman, that recommendations be explained, and that her preference for therapeutic or diagnostic modalities be carried out. Matters of

Beneficence and respect for autonomy in obstetric practice

The obstetrician's perspective on the pregnant woman's health-related interests provides the basis for beneficence-based obligations owed to her. The woman's own perspective on her interests provides the basis for autonomy-based obligations owed to her. Because of its insufficiently developed central nervous system the fetus cannot meaningfully be said to possess values and beliefs. Thus, there is no basis for saying that a fetus has a perspective on its interests. There can therefore be no


In conclusion, ethics is an essential dimension of the practice of obstetrics and gynecology. The framework we have used in this paper, based on ethical principles, is not limited to the American context. Rather, as Gillon has persuasively argued, principle-based medical ethics applies across different cultural and national contexts [12]. Moreover, the approach we have taken here balances beneficence and respect for autonomy so that neither has an inappropriate emphasis in the ethics of

References (12)

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    Am J Obstet Gynecol


  • McCullough LB, Chervenak FA. Ethics in Obstetrics and Gynecology. New York: Oxford University Press,...
  • Beauchamp TL, Childress JF. Principles of Biomedical ethics. 4th ed. New York: Oxford University Press,...
  • Hippocrates. Epidemics i:xi. [Jones, W.H.S. Trans.]. Loeb Classical Library, vol. 147. Cambridge: Harvard University...
  • Faden RR, Beauchamp TL. A History and Theory of Informed Consent. New York: Oxford University Press,...
  • M. Hack et al.

    Outcomes of extremely-low-birth-weight infants between 1982 and 1988

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There are more references available in the full text version of this article.

Cited by (26)

  • Effect of twin pregnancy chorionic properties on maternal and fetal outcomes

    2018, Taiwanese Journal of Obstetrics and Gynecology

    The maternal complications included gestational hypertension, gestational diabetes mellitus, polyhydramnios, premature rupture of membranes, abruptio placenta, premature delivery, and severe postpartum hemorrhage; the fetal adverse outcomes mainly included fetal loss in early and mid pregnancy (abortion and dead fetus), complex twins (inconsistent development, death of one of the twins, deformity in one of the twins, selective fetal growth restriction, fetofetal transfusion syndrome, and twin anemia-polycythemia sequence), neonatal asphyxia, and perinatal death. These diagnostic criteria were obtained from the National Medical Colleges Obstetrics and Gynecology (eighth edition) [8] and published literature [9]. Among the 559 subjects, 35.42% had MCDA, while 64.58% had DCDA.

    This study aimed to determine the effect of twin pregnancy chorionic properties on pregnancy complications and fetal outcomes.

    A total of 559 subjects with gemellary pregnancy were included in the retrospective analysis, and clinical data, such as monitoring data during pregnancy and maternal and fetal outcomes, were recorded in detail. Based on the ultrasound results and methods of the postpartum pathologic examination of the placental membranes, the subjects were divided into the twin group with monochorionic diamnion (MCDA group, n=198) and twin group with dichorionic diamnion (DCDA group, n=361). The relationships of different chorionic properties and maternal and fetal outcomes were determined by comparing the maternal complications and fetal outcomes.

    The occurrence rate of gemellary pregnancy was 2.97% and that of monochorionic twin pregnancy was 34.8%. The MCDA group showed a higher incidence of pregnancy-induced hypertension, gestational diabetes mellitus, polyhydramnios, premature rupture of membranes, and abruptio placenta and a lower incidence of severe postpartum hemorrhage than the DCDA group. However, the incidence of preterm birth was significantly different (57.6% vs. 45.7%, P<0.05). Significant differences were also detected in the incidence of fetal loss, complicated twins, neonatal asphyxia, and perinatal death between the two groups (P<0.05).

    (Video) Progress 2003: "Ethics in Obstetrics & Gynaecology - A disappearing Act 1" by Dr. Evita Fernandez

    The incidence of maternal complication (such as pregnancy-induced hypertension, gestational diabetes mellitus, polyhydramnios, premature rupture of membranes, and abruptio placenta and severe postpartum hemorrhage) in the two groups was not significantly different; however, the fetal outcomes in the MCDA group were inferior to those in the DCDA group. The fetal outcomes may be improved by determining the chorionic properties in early pregnancy by using ultrasound and consequently planning for pregnancy monitoring and intervention.

  • Ethical issues in research

    2017, Best Practice and Research: Clinical Obstetrics and Gynaecology

    The concept of the fetus as a patient has evolved in recent years; thereby new ethical issues have emerged and are being addressed. Currently, directive versus nondirective counseling includes fetal benefits [18]. Ethical principles are currently guided by justice (a concept of fairness administered lawfully).

    Biomedical research is currently guided by ethical standards that have evolved over many centuries. Historical and political events, social and legal considerations, and continuous medical and technological advances have led to the prevailing research ethics and practice. Currently, patients and research subjects have complete autonomy while under medical care or when volunteering as research subjects. Enrolling volunteers in human subjects research includes a detailed and meaningful informed consent process that follows the cardinal principles of ethics: autonomy, beneficence, nonmaleficence, and justice. These principles were gradually adopted after World War II, primarily in response to the unethical behavior of German physicians and scientists during the Third Reich. This review emphasizes the importance of historical milestones and the essential role that ethics has in contemporary medical research. Research protocols should achieve maximum benefits for the society, have clinical and scientific value, be subject to independent review, respect human dignity, and follow the principles of informed consent, and most importantly, subjects should have complete autonomy. However, current principles and regulations cannot cover every conceivable situation, particularly in view of the new advances in science and technology. New and evolving medical technology, genetic research, therapeutic interventions, and innovations challenge society to maintain the highest moral and ethical principles.

  • The suleman octuplet case: An Analysis of multiple ethical issues

    2010, Women's Health Issues

    Despite regulations and guidelines, the ethical obligations of physicians to their infertile patients remain unchanged. Regardless of the number of embryos any particular practitioner judges appropriate to transfer, the doctrine of informed consent and the ethical principles of autonomy and beneficence require a clear duty of care to both the mother and her potential children, when the mother presents her potential children as patients (Chervenak & McCullough, 1995, 1996, 1997, 2001, 2003; Chervenak et al., 2003; McCullough & Chervenak, 1994, 2008). The first publicized case of a natural HOM birth was the Dionne quintuplet case (Canada, 1934).

    The Suleman octuplet case is the first reported case in which surviving octuplets were born as a result of in vitro fertilization and embryo transfer. In this case, the octuplets were born to an American single mother of six children, who was on public assistance, and who used a sperm donor. This has raised multiple ethical questions, which include the ethical obligations of the health care providers involved, the informed consent process, as well as moral obligations of the mother to her existing children and unborn children. This case analysis provides a clinical ethics and prenatal ethics framework, based on relevant American media and public documents available from January 26, 2009, to January 26, 2010, the period of time in which media scrutiny of this case was most relevant. Although this analysis introduces broader ethical implications, it is not intended as a philosophical discourse regarding the rights of patients to reproduce or the rights of society to place limits on who can and who cannot reproduce; neither is it intended as an in-depth policy review of reproductive technologies. Rather, this analysis focuses on clinical ethics breaches in this particular case, which led to an unintended outcome. The relevant clinical ethical principles, duties, and obligations are identified, with recommendations for a preventative ethics approach in the absence of clear policies that regulate embryo transfer.

  • Discrepancy between physicians' perceptions and practices during pelvic examinations in Taiwan

    2009, Patient Education and Counseling

    This study explored (1) physicians’ perceptions of pelvic examination (PE) procedures and (2) the discrepancy between physicians’ perceptions and their practices as observed by their attending nurses.

    Data were collected from 20 physician-completed questionnaires on the perceived importance of 23 PE procedures. Each physician’s practice of the same 23 PE procedures was assessed by 4–6 attending nurses (100 nurse observations). Physicians and nurses were sampled by convenience from the obstetrics/gynecology outpatient departments of 3 teaching hospitals in central Taiwan. Discrepancies between physicians’ perceptions and their practices as assessed by attending nurses were examined by the Mann–Whitney U test.

    Physicians’ mean scores ranged from 3.15 to 4.00, indicating that PE procedures were generally perceived as important. The procedures were rank ordered according to the mean scores from highest to lowest. Physicians’ 5 top-ranking procedures were wearing gloves during the PE, asking agreement for the examination, paying attention to privacy during the PE, protecting the woman’s personal information, and protecting the woman’s medical records. Physicians’ 5 lowest ranking procedures were telling the woman before inserting the speculum that she will feel some pressure, explaining the procedure before the PE, proactively providing information, asking the woman how she feels during the PE, asking a woman’s permission to examine prior to commencing the PE, and describing observations to the woman during the PE (the last two procedures were tied for 5th rank). For 15 of the 23 PE procedures, physicians’ perceptions did not differ significantly from their practices as assessed by attending nurses. The remaining 8 procedures were statistically significant between physicians’ perception and their practices, and were rated higher by physicians (perception) than by attending nurses (practice).

    The 5 top-ranking PE procedures in terms of perceived importance were related to procedural behaviors, whereas the 5 lowest ranking procedures were verbal statements with explicit affective content. During nurse-observed PEs, Taiwanese physicians consistently practiced the procedural aspects of PEs they perceived as important (e.g., communication and consultation, protection and skilled technique, and confidentiality). However, physicians’ practices were less consistent in affective aspects (e.g., explanation and consent, information and instruction, and sensitivity).

    Our results suggest that physicians should concentrate not only on procedural behaviors, but also on affective behaviors. These findings could be incorporated in medical education, particularly for medical students training to become obstetric and gynecological physicians.

  • Ethical considerations in caring for women with substance use disorders

    2003, Obstetrics and Gynecology Clinics of North America


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View full text

Copyright © 1997 Elsevier Science Ireland Ltd. All rights reserved.


Why is autonomy important in ethics? ›

The principle of autonomy provides the patient the option to delegate decision-making authority to another person.

What are some ethical considerations in delivery? ›

Key ethical principles shared by all three of these groups include promoting the well-being of the patient/client, practicing informed consent, respecting the patient's/client's right to privacy, providing only those services for which the professional is qualified, and having respect for diversity.

What is medical ethics and why is it important? ›

Health care ethics (aka “medical ethics” or “bioethics”), at its simplest, is a set of moral principles, beliefs and values that guide us in making choices about medical care. At the core of health care ethics is our sense of right and wrong and our beliefs about rights we possess and duties we owe others.

What is the study of obstetrics and gynecology? ›

Listen to pronunciation. (ob-STEH-trix ... GY-neh-KAH-loh-jee) A branch of medicine that specializes in the care of women during pregnancy and childbirth and in the diagnosis and treatment of diseases of the female reproductive organs.

What is the most important ethical principle? ›

Using the AHP to measure the relative importance of the different medical ethical principles for individuals, the most important principle is, without ambiguity, “Non maleficence”.

What are ethical principles? ›

Definition. Ethical principles are part of a normative theory that justifies or defends moral rules and/or moral judgments; they are not dependent on one's subjective viewpoints.

What are considered ethical issues? ›

The most commonly experienced ethical issues include discrimination, harassment, unethical accounting, technological abuse, data privacy, health and safety, and favoritism and nepotism. Most of these concerns are experienced in workplaces.

What are the principles of ethics in nursing? ›

Nurses are advocates for patients and must find a balance while delivering patient care. There are four main principles of ethics: autonomy, beneficence, justice, and non-maleficence. Each patient has the right to make their own decisions based on their own beliefs and values. [4].

How do you answer medical ethics questions? ›

Essential things to remember when answering ethical questions:
  1. Show respect to the patient.
  2. Don't be hostile toward the patient.
  3. Show a good, thorough thought process in responding to the questions.
  4. Take a firm stance about what you believe.
  5. Think in the grand scheme of things, aiming to achieve the greater good.

What are the goals of medical ethics? ›

Thus they protect not only patients but also care providers and their institutions by setting standards of conduct that ultimately promote the trust of patients, professional colleagues, and the general public. The four cornerstones of medical ethics are respect for autonomy, beneficence, nonmaleficence, and justice.

What is an example of ethics in healthcare? ›

Ethical decision-making in healthcare.

For example, a patient may refuse care due to cultural/religious views, or may want an unnecessary treatment which may not be in his or her best interests; euthanasia is another example of a provider's sense of morals conflicting with his or her ethical obligations.

What is difference between obstetrics and gynecology? ›

A gynecologist is primarily involved in the reproductive care while an obstetrician cares for the health of women during and after pregnancy. Later one also deals with the health of the fetus, and her duties involve monitoring of womb throughout gestation.

Why is it called gynecology? ›

Gynae means woman in Greek

Most biomedical words, including 'gynaecology' originate from ancient Greek. The word is made up of a combination of two parts, γυνή/gyne which means woman or female and –λογία/ -logia which is a suffix and means the study of, or discourse about something.

What is difference between gynecologist and obstetrician? ›

While OB/GYN is considered one specialty, it comprises two distinct fields. Obstetrics (the OB) involves care during pre-conception, pregnancy, childbirth, and immediately after delivery. Gynecology (the GYN) involves care of all women's health issues.

Why are ethical principles important? ›

Ethics is what guides us to tell the truth, keep our promises, or help someone in need. There is a framework of ethics underlying our lives on a daily basis, helping us make decisions that create positive impacts and steering us away from unjust outcomes.

What are the 3 requirements of ethics? ›

Three basic principles, among those generally accepted in our cultural tradition, are particularly relevant to the ethics of research involving human subjects: the principles of respect of persons, beneficence and justice.

What are the 7 principles of medical ethics? ›

This approach – focusing on the application of seven mid-level principles to cases (non-maleficence, beneficence, health maximisation, efficiency, respect for autonomy, justice, proportionality) – is presented in this paper. Easy to use 'tools' applying ethics to public health are presented.

What are the 4 medical ethics? ›

The four prima facie principles are respect for autonomy, beneficence, non-maleficence, and justice.

How do you overcome ethical issues? ›

Five Ways to Reduce Ethics and Compliance Risk
  1. Honestly assess your needs and resources.
  2. Establish a strong foundation.
  3. Build a culture of integrity — from the top down.
  4. Keep a “values focus” in moments big and small.
  5. Re-evaluate and revise as needed.
25 Oct 2021

What is the biggest ethical problem in healthcare? ›

Patient Confidentiality

One of the biggest legal and ethical issues in healthcare is patient confidentiality which is why 15% of survey respondents noted that doctor-patient confidentiality is their top ethical issue in practicing medicine.

How can ethical issues be resolved? ›

A 10-Step Process for Resolving Ethical Issues
  1. Identify the problem as you see it.
  2. Get the story straight—gather relevant data. ...
  3. Ask yourself if the problem is a regulatory issue or a process issue related to regulatory requirements.
  4. Compare the issue to a specific rule in ASHA's Code of Ethics.

What are the 5 ethical considerations? ›

Ethical considerations during evaluation include:
  • Informed consent.
  • Voluntary participation.
  • Do no harm.
  • Confidentiality.
  • Anonymity.
  • Only assess relevant components.

Why are ethical principles in nursing important? ›

Ethical values are particularly important in the nursing profession because nurses fill the role of caregiver for patients. These values help guide practitioners to make decisions that will best support the physical, mental and emotional health of each individual patient.

How can nurses resolve ethical issues? ›

7 Tips for Nurses Dealing with Ethical Dilemmas
  1. Understand the Uniqueness of the Dilemma. ...
  2. Refer to the Code of Ethics. ...
  3. Seek Ethics Education. ...
  4. Speak Up. ...
  5. Seek Perspective. ...
  6. Reach Out to Professional Organizations/Associations. ...
  7. Seek Counseling.
20 Jun 2018

What is an example of ethics in nursing? ›

Nurses have an obligation not to inflict harm and not to allow others to inflict harm. They must also promote good actions on behalf of their patients. Examples of nonmaleficence are always being truthful to patients and never allowing one patient to be harmed for the benefit of another.

How can we promote ethics in nursing? ›

Exemplifying Ethics in Nursing Leadership

Identify and discuss the nursing unit's common ethical dilemmas. Organize an ethics committee or identify ethical champions in everyday life. Develop ethics-friendly policies and procedures. Provide continuing education and training in ethical decision making.

What are some examples of ethical questions? ›

Should you or should you not let them? Is it fair to the others in the class? What harm can it cause to you or others?

What are some good ethical questions? ›

  • Is morality subjective (based on personal opinion) or objective (based on actual fact)?
  • Is it ever okay to lie? ...
  • Is it ever okay to kill? ...
  • Is any one person's life worth more than another's? ...
  • Do evil people exist? ...
  • Can a good person do evil things and remain a good person?
10 Feb 2021

How do you answer an ethical question MMI? ›

Answering ethical MMI questions requires the applicant to weigh both sides of the issue thoughtfully, examine every outcome, and decide what's best based on the given situation. It is important to understand the ethical tension present and clearly elaborate on any relevant details.

What is a doctors code of ethics? ›

A physician shall uphold the standards of professionalism, be honest in all professional interactions, and strive to report physicians deficient in character or competence, or engaging in fraud or deception, to appropriate entities.

Why is ethics important in healthcare research? ›

It is important to adhere to ethical principles in order to protect the dignity, rights and welfare of research participants. As such, all research involving human beings should be reviewed by an ethics committee to ensure that the appropriate ethical standards are being upheld.

When did medical ethics begin? ›

The Code of Medical Ethics (Code) of the American Medical Association (AMA) is rooted in an understanding of the goals of medicine as a profession, which dates back to the 5th century BCE and the Greek physician Hippocrates, to relieve suffering and promote well-being in a relationship of fidelity with the patient.

What are three ethical issues in healthcare today? ›

5 Ethical Issues in Healthcare
  • Do-Not-Resuscitate Orders. ...
  • Doctor and Patient Confidentiality. ...
  • Malpractice and Negligence. ...
  • Access to Care. ...
  • Physician-Assisted Suicide.

Why is code of ethics important in healthcare? ›

Code of Ethics for Healthcare Quality Professionals

A code of ethics clarifies roles and responsibilities within a profession and provides guidance to the professional for addressing common ethical questions.

What is the importance of autonomy? ›

When employees have autonomy in the workplace, they develop self-reliance and resilience. These are two of many important leadership skills. Since independent thought is synonymous with problem-solving, a workplace based on autonomy is a perfect work environment for building leaders.

Why is autonomy the most important? ›

Exercising patient autonomy empowers patients to feel more in control and confident in their ability to make educated health decisions and choose the right doctors. Autonomy leads to positive health outcomes, as we will witness in the stories of three patients.

What does autonomy mean in ethics? ›

autonomy, in Western ethics and political philosophy, the state or condition of self-governance, or leading one's life according to reasons, values, or desires that are authentically one's own.

What is autonomy in ethical principle? ›

Autonomy. The third ethical principle, autonomy, means that individuals have a right to self-determination, that is, to make decisions about their lives without interference from others.

What is beneficence in medical ethics? ›

More commonly in medical ethics, beneficence is understood as a principle requiring that physicians provide, and to the best of their ability, positive benefits such as good health, prevent and remove harmful conditions from patients.

What is an example of autonomy in ethics? ›

For example, a person who is not imprisoned can make decisions and act according to personal desires and motives. This person has some degree of personal autonomy, depending on the other external factors, such as peer pressure or an authority figure, which may be guiding his or her actions.

What does justice mean in medical ethics? ›

Justice. The principle of justice in medical ethics refers to a fair and equitable distribution of health resources. One part of seeking justice is promoting the fiscal sustainability of the health system for the greater good of society, which is where value comes into play.

Do patients have the ethical right to refuse treatment? ›

Every competent adult has the right to refuse unwanted medical treatment. This is part of the right of every individual to choose what will be done to their own body, and it applies even when refusing treatment means that the person may die.

What are the four major ethical principles? ›

The 4 basic ethical principles that apply to forensic activities are respect for autonomy, beneficence, nonmaleficence, and justice.

What is ethical decision-making? ›

Ethical decision-making refers to the process of evaluating and choosing among alternatives in a manner consistent with ethical principles. In making ethical decisions, it is necessary to perceive and eliminate unethical options and select the best ethical alternative.

What are the 7 principle of ethics? ›

The principles are beneficence, non-maleficence, autonomy, justice; truth-telling and promise-keeping.

What is an example of beneficence? ›

Beneficence. Beneficence is defined as kindness and charity, which requires action on the part of the nurse to benefit others. An example of a nurse demonstrating this ethical principle is by holding a dying patient's hand.

What is an example of justice in ethics? ›

Rules that prevent smoking in residents' rooms are enforced without exception as dictated by the principle of Justice, thereby restricting individual autonomy. Therefore, Justice demands that one's right to exercise Autonomy is limited when it affects the safety and well-being of another person.

Why is beneficence important in ethics? ›

Why Is Beneficence Important? Beneficence is important because it ensures that healthcare professionals consider individual circumstances and remember that what is good for one patient may not necessarily be great for another.

Why is ethics important in nursing? ›

The nursing code of ethics helps caregivers consider patient needs from several viewpoints and maintain a safe recovery environment. Ethical guidelines remind caregivers to treat all people equitably and individually, while protecting the privacy rights of patients in ways that may not seem overtly obvious.

Which of the following ethical principles means to cause no harm? ›

Nonmaleficence (do no harm) Obligation not to inflict harm intentionally; In medical ethics, the physician's guiding maxim is “First, do no harm.” Beneficence (do good) Provide benefits to persons and contribute to their welfare. Refers to an action done for the benefit of others.


1. Ethics, Research and Pregnancy Guidance and Lessons from the PHASES Project
(U of M Center for Bioethics)
2. Session 6 Legal and Ethical Issues in Obstetrics, Gynaecology and Neonatology Practice
(Hospital Management)
3. Ethical & Legal Aspects in Midwifery & Obstetrical Nursing
(Lecture by Abhilasha Verma)
4. Frank Chervenak, MD - Professional Ethics in Obstetrics Practice and Research
(MacLean Center for Clinical Medical Ethics)
5. Scientific and Ethical Considerations for the Inclusion of Pregnant Women in Clinical Trials: Day 1
(Duke Margolis)
6. Clinical Ethics at the Bedside: A Primer for the OB/GYN
(The College Video Portal)

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