[HD 201] E03-T07-Ethical & Social Issues in Family Planning_compressed

Clinical Ethics

• Explores ethical dilemmas in clinical practice using a structured approach.
• Commonly uses the Four Principles or Principlism approach.

Four Ethical Principles

Beneficence

• Involves providing benefits and promoting the well-being of others.
• Requires positive actions to help others.

Nonmaleficence

• This is the obligation to avoid causing harm or injury.
• Follows the principle of "primum non nocere," meaning "first, do no harm."

Respect of Autonomy

• Acknowledges the patient’s right to hold views, make choices, and take actions based on personal values and beliefs.
• Respects the decision-making capacity of competent persons.

Justice

• Requires fairness in the distribution of benefits and risks.
• Requires equitable allocation of health resources for all, irrespective of various factors.

Ethical Guidelines

• Includes guidelines from FIGO and the Philippine Obstetrical and Gynecological Society.
• WHO provides guidelines to ensure human rights in contraceptive information and services.

Role of OB/GYN as Advocates

• Advocates role in women's health include:
• Ethical duty to advocate for women's health care.
• Possess knowledge encompassing sexual and reproductive health. Have a duty to provide care based on their knowledge and experience

Common Objections to Contraception

• Claims that it is unnatural, anti-life, or a form of abortion.
• Concerns that it may lead to promiscuity or pose health risks.

POGS & FIGO Guidelines: Contraception

• Respects the person's right to choose and decide upon concerns related to sexuality and reproductive health.
• States OB-GYNs must provide updated, evidence-based information to ensure the safest option is reached.
• Upholds information and access regardless of age, marital status, education, social standing or gender.
• Actively remove barriers that deny a patient's right to information and informed choice.
• Hormonal contraceptives and IUDs are currently available in local health centers and LGUs.
• Midwives and barangay health workers are also trained on IUD insertion.

Beneficence and Contraception

• It is a duty to offer methods that are safe, effective, and acceptable.
• Must ensure medical quality.
• Give generic names when prescribing to offer cheaper patient options
• Must offer supportive counseling services that are accessible.
• All providers must be knowledgeable and technically competent.

Autonomy and Contraception

• Physicians must consider the patient's expressed wishes.
• Patients should be informed of their right to stop using a method at any time and ensured they are not coerced.
• Physicians are ethically required to eliminate obstacles to informed choice and address power imbalances.

Informed Choice

• Women can freely make decisions about possible health interventions and exercise their rights.
• Based on accurate, unbiased, complete, and comprehensible information.

Informed Consent

• Willing and uncoerced acceptance of medical intervention after adequate disclosure by the physician.
• Obligations derive from international documents like the Universal Declaration of Human Rights.

Informed Consent Process

• Physicians must completely and accurately disclose all information.
• Should ensure safety and confidentiality.
• The most important aspect of this is patient autonomy.
• Allows the patient time to arrive at a decision based on their understanding of the information

Informed Choice on Contraception

• Women should be given clear information on contraceptive methods.
• Information on use, contraindications, effectiveness, STI protection, side effects, and drug interactions should be disclosed.

Physician's Obligation to Disclose Information

• Doctors have a legal and ethical obligation to give women interested in contraception information on all medically reasonable alternatives.
• This must be presented without bias and based on the best available evidence.
• Should explain any clinical contraindications to ensure transparency.

Physician's Point of View: Case 1

• The doctor should give information and cannot refuse to give advice.
• Refusal violates a patient's right to informed choice, undermining reproductive rights.
• Invoke conscientious objection without abandoning the patient.

Doctor Responsibility: Case 1

• There is a responsibility to refer the patient in a timely manner.
• Must prescribe necessary medication, in accordance with beneficence.
• No known medical condition contraindicates contraception for this patient.

Patient's Point of View: Case 1

• Patients can demand necessary services.
• The patient cannot be denied services based on moral, marital, or personal grounds.
• The patient can demand necessary services and expect appropriate referral, if needed.
• All individuals can seek reproductive health care services, regardless of marital status.

Physician's Point of View: Case 2

• The doctor's next steps include respectfully listening to the patient's request, assess medical history, ensure the patient is fully informed.
• The process must involve documentation of counseling and any referral.

Sterilization: Ethics

• The patient is entitled to all of the information.
• The doctor is entitled to refuse the procedure.
• This should not affect the patients decision.
• It is not ethical to consider the number of children while sterilizing.

Sterilization: OB/GYN Recommendations

• OB-GYNs should ensure counseling is delivered in a language the patient understands.
• forced sterilization constitutes an act of violence, and the patient should never undergo sterilization.
• All physicians must recognize and fulfill their duty to be a voice of reason and compassion

Conscientious Refusal

• Doctors have a duty to refer patients in a timely matter and do not deny care even in an emergency
• This is where physician cannot provide reproductive services that respect the patient's request.
• Must provide prior and accurate notice of any personal moral commitments
• All providers must practice in proximity to those who share views and must provide their services to all

Limits for Conscientious Refusal

• Ensure there is no imposition on patient beliefs and that they are not breached.
• Scientific integrity is important when patients claim refusal.
• Avoids scientific claims that may have potential for discrimination.

Potential for Discrimination

• Treat individuals fairly and to provide medical services in a nondiscriminatory manner.
• Includes right to information, education, and provide healthcare.

Sexual and Reproductive Rights

• They include reproductive health and the right for Women & men to decide matters related to their sexuality.
• Consists of access to safe/legal/effective methods of fertility while consistent with their beliefs.

Case #2: Physician's Point of View Considerations

• Physicians must listen to the patient's request and assess their medical history.
• Physicians must ensure that patients are fully informed.
• Any physicians refusing to conduct a procedure must ensure that their personal beliefs do not affect patient care.
• Respect for the patient's autonomy should always guide any medical recommendations.

Case #2: Points regarding patient healthcare

• In this scenario healthcare decisions are guided by justice, respect for autonomy, beneficence, and nonmaleficence.
• It is essential to avoid imposing personal beliefs and ensuring impartiality in patient care.
• Physicians should also support open discussions, although final decisions rest with the patient.