Obstetrics Archives - Page 2 of 3 - Protection of Conscience Project Library

Obstetrician-gynecologist physicians’ beliefs about emergency contraception: a national survey

Ryan E Lawrence, Kenneth A Rasinski, John D Yoon, Farr A Curlin

Abstract
Background: Although emergency contraception (EC) is available without a prescription, women still rely on doctors’ advice about its safety and effectiveness. Yet little is known about doctors’ beliefs and practices in this area.

Study design: We surveyed 1800 US obstetrician-gynecologists. Criterion variables were doctors’ beliefs about EC’s effects on pregnancy rates, and patients’ sexual practices. We also asked which women are offered EC. Predictors were demographic, clinical and religious characteristics.

Results: Response rate was 66% (1154/1760). Most (89%) believe EC access lowers unintended pregnancy rates. Some believe women use other contraceptives less (27%), initiate sex at younger ages (12%) and have more sexual partners (15%). Half of physicians offer EC to all women (51%), while others offer it never (6%) or only after sexual assault (6%). Physicians critical of EC, males and religious physicians were more likely to offer it never or only after sexual assault (odds ratios 2.1-12).

Conclusion: Gender, religion and divergent beliefs about EC’s effects shape physicians’ beliefs and practices.

Lawrence RE, Rasinski KA, Yoon JD, Curlin FA. Obstetrician-gynecologist physicians’ beliefs about emergency contraception: a national survey. Contraception. 2010;82(324-330.

Abortion and human rights

Dorothy Shaw

Best Practice and Research Clinical Obstetrics & Gynaecology

Abstract
Abortion has been a reality in women’s lives since the beginning of recorded history, typically with a high risk of fatal consequences, until the last century when evolutions in the field of medicine, including techniques of safe abortion and effective methods of family planning, could have ended the need to seek unsafe abortion. The context of women’s lives globally is an important but often ignored variable, increasingly recognised in evolving human rights especially related to gender and reproduction. International and regional human rights instruments are being invoked where national laws result in violations of human rights such as health and life. The individual right to conscientious objection must be respected and better understood, and is not absolute. Health professional organisations have a role to play in clarifying responsibilities consistent with national laws and respecting reproductive rights. Seeking common ground using evidence rather than polarised opinion can assist the future focus.

Shaw D. Abortion and human rights. Best Practice and Research Clin Ob Gyn. 2010;24(5):633-646.

An ethically justified practical approach to offering, recommending, performing, and referring for induced abortion and feticide

Frank A Chervenak, Laurence B McCullough

American Journal of Obstetrics & Gynecology

Abstract
We provide comprehensive, practical guidance for physicians on when to offer, recommend, perform, and refer patients for induced abortion and feticide. We precisely define terminology and articulate an ethical framework based on respecting the autonomy of the pregnant woman, the fetus as a patient, and the individual conscience of the physician. We elucidate autonomy-based and beneficence-based obligations and distinguish professional conscience from individual conscience. The obstetrician’s role should be based primarily on professional conscience, which is shaped by autonomy-based and beneficence-based obligations of the obstetrician to the pregnant and fetal patients, with important but limited constraints originating in individual conscience.

Chervenak FA, McCullough LB. An ethically justified practical approach to offering, recommending, performing, and referring for induced abortion and feticide. Am J Obstet Gynecol. 2009 Dec;201(6):560.e1-560.e6.

Opinion no. 385: The Limits of Conscientious Refusal in Reproductive Medicine

American College of Obstetricians and Gynecologists

American College of Obstetricians & Gynecologists

Abstract
Health care providers occasionally may find that providing indicated, even standard, care would present for them a personal moral problem-a conflict of conscience particularly in the field of reproductive medicine. Although respect for conscience is important, conscientious refusals should be limited if they constitute an imposition of religious or moral beliefs on patients, negatively affect a patient’s health, are based on scientific misinformation, or create or reinforce racial or socioeconomic inequalities. Conscientious refusals that conflict with patient well-being should be accommodated only if the primary duty to the patient can be fulfilled. All health care providers must provide accurate and unbiased information so that patients can make informed decisions. Where conscience implores physicians to deviate from standard practices, they must provide potential patients with accurate and prior notice of their personal moral commitments. Physicians and other health care providers have the duty to refer patients in a timely manner to other providers if they do not feel that they can in conscience provide the standard reproductive services that patients request. In resource-poor areas, access to safe and legal reproductive services should be maintained. Providers with moral or religious objections should either practice in proximity to individuals who do not share their views or ensure that referral processes are in place. In an emergency in which referral is not possible or might negatively have an impact on a patient’s physical or mental health, providers have an obligation to provide medically indicated and requested care.

ACOG. The Limits of Conscientious Refusal in Reproductive Medicine. ACOG Committee on Ethics. 2007;385):1-6.

What is the relevance of women’s sexual and reproductive rights to the practising obstetrician/gynaecologist?

Dorothy Shaw, Anibal Faúndes

Abstract
Women’s sexual and reproductive rights are an integral part of daily practice for obstetricians/gynaecologists and the key to the survival and health of women around the world. Women’s sexual and reproductive health is often compromised because of infringements of their basic human rights, not the lack of medical knowledge. Understanding the relevance of respecting and promoting sexual and reproductive rights is critical for providing current standards of care, and includes access to information and care, confidentiality, informed consent and evidence-based practice. The violation of women’s rights in their daily lives through common problems such as gender-based violence and discrimination results in serious consequences for their health. Obstetricians/gynaecologists are natural advocates for women’s health, yet may be lacking in their understanding of relevant laws or the limits of conscientious objection. This chapter outlines the framework for sexual and reproductive rights, and explores its relevance to the practising clinician.

Shaw D, Faúndes A. What is the relevance of women’s sexual and reproductive rights to the practising obstetrician/gynaecologist? Best Practice and Research Clinical Obstetrics and Gynaecology. 2006 Jun;20(3):299-309.

Committee for the Ethical Aspects of Human Reproduction and Women’s Health. Ethical guidelines on conscientious objection

Gamal I Serour, International Federation of Gynecology and Obstetrics (FIGO)

International Journal of Gynecology & Obstetrics

Abstract
The FIGO Committee for the Ethical Aspects of Human Reproduction and Women’s Health held a combined meeting with the Committee of Women’s Sexual and Reproductive rights to discuss ethical aspects of issues that impact the discipline of Obstetrics, Gynecology, and Women’s Health. The following document represents the result of that carefully researched and considered discussion. This material is not intended to reflect an official position of FIGO, but to provide material for consideration and debate about these ethical aspects of our discipline for member organizations and their constituent membership.

Serour GI, FIGO. Committee for the Ethical Aspects of Human Reproduction and Women’s Health. Ethical guidelines on conscientious objection. Int J Gyn Ob. 2006 Feb 03;92(3):333-334.

When caesarian section operations imposed by a court are justified

Eike-Henner Kluge

Abstract
Court-ordered caesarian sections against the explicit wishes of the pregnant woman have been criticised as violations of the woman’s fundamental right to autonomy and to the inviolability of the person-particularly, so it is argued, because the fetus in utero is not yet a person. This paper examines the logic of this position and argues that once the fetus has passed a certain stage of neurological development it is a person, and that then the whole issue becomes one of balancing of rights: the right-to-life of the fetal person against the right to autonomy and inviolability of the woman; and that the fetal right usually wins.

Kluge E-H. When caesarian section operations imposed by a court are justified. J Med Ethics. 1988 Dec;14(4) 206-211.

(News) Canadian obstetric care system among finest in world, major CMA study finds

Patrick Sullivan

Canadian Medical Association Journal, CMAJ — Canadian Medical Association Journal

Extract
Canada’s standard of obstetric care is excellent, and although some improvements can be made, they can be carried out within the existing system. That is the main finding from a major CMA study on obstetric care, the first of its kind in Canada, which has been sent to association members with this issue of CMAJ. . . . There is no reason for Canada to introduce a midwifery system since there is neither a calculable need nor a significant demand, the CMA has concluded.

Sullivan P. Canadian obstetric care system among finest in world, major CMA study finds. Can Med Assoc J. 1987;136(6):643, 646, 648-649.

(Correspondence) The Canadian abortion law

Margaret Wynn, Arthur Wynn

Extract
Your correspondents Dr. Coffey and Drs. Cohen, Rapson and Watters (ibid, page 213) all refer to our review, published over 4 years ago,1 of the consequences of induced abortion to children born subsequently. Much progress has since been made in Europe in preventing these consequences . . .

The main conclusions of our 1972 review have, indeed, been confirmed in many subsequent studies and more
recent reviews. It may reasonably be inferred from the Bristol study and from other European studies that between 20 and 25% of women who have had an induced abortion need a cerclage operation to be able to carry a subsequent pregnancy to term. The percentage may well be lower in Canada if a higher percentage of abortions are undertaken earlier in pregnancy. . .

It is important for any woman who hopes to have a child subsequent to an induced abortion to accept that she will then be in a high-risk category and must report a subsequent pregnancy early, and that she will need specialist obstetric care. . . .

Cohen and her colleagues describe us as “two crusaders for compulsory pregnancy”. This is untruthful abuse. Your correspondence columns might better be used to discuss the many steps that might be taken in Canada to reduce the unfortunate consequences of induced abortion, including the careful counselling of women and the wider use of the cerclage operation early enough in a subsequent pregnancy.

Wynn M, Wynn A. (Correspondence) The Canadian abortion law. Can Med Assoc J. 1977 Feb 05;116(3):241-243.

The unwanted pregnancy

Sharon H Stone, Kenneth E Scott

Authors’ Summary
A questionnaire was submitted to the mothers of 200 consecutively delivered infants; 15% of mothers were unmarried. The results showed a high prevalence of unwanted pregnancy, most accounted for by well educated, married women having their first or second baby, and despite access to contraceptive agents. Most of the married women and over 50% of the unmarried who had not wanted to become pregnant wanted the baby after its birth.

Stone SH, Scott KE. The unwanted pregnancy. Can Med Assoc J. 1974;111(10):1093-1097.