Lecture 5 - Legal and Ethical issues in midwifery practice.pdf

Dr EnasMohamed Lofty Associated Professor In Nursing Administration College Of Nursing, PNU Lecture 3 1  Learning objectives On completion of this lecture, the student will be able to: Outline the common ethical issues and challenges i...

Dr EnasMohamed Lofty Associated Professor In Nursing Administration College Of Nursing, PNU Lecture 3 1  Learning objectives On completion of this lecture, the student will be able to: Outline the common ethical issues and challenges in midwifery practice. Ethical issues and challenges 1. Substance abuse 2. Refusal of medical treatment 3. Informed consent 4. Female sterilization 5. Forced caesarean birth 6. Abortion 7. In vitro fertilization and embryo transfer 8. Surrogacy ‫تأجي األرحام‬‫ر‬ Ethical issues and challenges-contd… 9-Selective reduction in multifetal pregnancy 10-Intrauterine treatment of fetal conditions 11Contraceptives 12-Infertility and ART (assisted reproductive technology) 13Human reproductive cloning 6. Abortion Abortion is a complex issue, and the controversy ‫الخالف والجدل‬is not only in the public , many nurses struggle with the conflict between their personal convictions and their professional duty. Abortion is the most difficult and controversial moral topic in today’s society.  Ethical issues in abortion There are two moral principles to consider; first, the moral status of the fetus and secondly, the right of the pregnant woman. Common ethical issues include: - Is the fetus a person with rights? - Does the woman have ethical obligations to the fetus? - Is it ethical to force a woman to carry a pregnancy to term? - Does the woman have ethical obligations to the father? - Is it ethical to give birth to an unwanted child?  Nurses and Abortion/ Medical termination of Pregnancy (MTP) Many abortions are performed illegally. Nurses have the right to refuse to assist in the procedure of the abortion. If the abortion is performed under the act of medical termination of pregnancy, she can assist the physician in this. Patient who has undergone abortion needs care and monitoring. It is the nurses legal responsibility to care for such client.  Legal Problems in MTP Medical Termination of Pregnancy Excessive or continued bleeding Injury to the organs Failure to diagnosis ectopic pregnancy while performing MTP Death following any procedure. MTP done by a not authorized person. MTP without proper counseling and informed consent. Termination knowingly after 20 weeks of pregnancy. Abortion in Saudi Arabia Abortion is legal only in cases of risk to a woman’s life - fetal impairment - to protect her physical and mental health - Pregnancy arising from incest or rape also qualify for a legal abortion The fetus must be less than four months old, and if longer, requires a panel of approved ‫لجنة من المختصي‬specialists to declare that the pregnancy will result in the death of the woman or serious damage to her health. Any approved abortion requires consent from three physicians as well as the patient and her partner. Abortion in Saudi Arabia-contd.. If an abortion is performed on a woman for any other reason, the violator may be required to pay blood money to the unborn child's family..‫فقد ُيطلب من المخالف دفع دية ألرسة الطفل الذي لم يولد بعد‬ Laws explicitly deny abortion to families who fear financial instability or an inability to provide the child with education. The selling of pills which are used for the process of abortion is illegal and has resulted in arrest  7. In vitro fertilization and embryo transfer ( IVF and ET) IVF involves removing a woman's egg from her ovaries and fertilizing it with sperm in a laboratory. An embryo transfer is the last part of the in vitro fertilization (IVF) process. During IVF, fertility medications are used to stimulate the ovaries into releasing healthy eggs. Embryo transfer: About 5-7 days after the egg retrieval, 1 or more embryos are put into your uterus. Issues in IVF and ET –contd.. Adequate information should be given about risk , benefits, success rate, alternative treatment, accurate information, adoption, surrogacy. Confidential issues of biologic and adoptive parents. Acceptance of donated sperms Clarify doubts about : - Frozen embryo for later use - Donors  8. Surrogacy Surrogacy is an arrangement, often supported by a legal agreement, whereby a woman agrees to bear a child for another person, who will become the child's parent after birth. Surrogacy is possible by AID (artificial insemination by donor)and IVF (in vitro fertilization) A lady without uterus but functioning ovaries can have a child with the help of a surrogate mother. Types of surrogacy Traditional surrogate: It's a woman who gets artificially inseminated with the father's sperm. They then carry the baby and deliver it for you and your partner to raise. A traditional surrogate is the baby's biological mother. That's because it was their egg that was fertilized by the father's sperm. Donor sperm can also be used. Gestational surrogates A technique called "in vitro fertilization" (IVF) now makes it possible to gather eggs from the mother (or an egg donor), fertilize them with sperm from the father (or a sperm donor), and place the embryo into the uterus of a gestational surrogate. The surrogate then carries the baby until birth. They don't have any genetic ties to the child because it wasn't their egg that was used. A gestational surrogate is called the "birth mother." The biological mother, though, is still the woman whose egg was fertilized.  Issues related to surrogacy Financial and moral responsibilities of child born with birth defects Issues related to right candidate selection Rights of surrogate mothers Surrogacy for convenience only is ethically unacceptable‫من أجل الراحة فقط‬ 9. Selective reduction in multifetal pregnancy Induced ovulation and in-vitro fertilization sometimes results in multi fetal pregnancies. If the number of exceeds the woman's ability to carry them to the point where they can survive outside the uterus, physician may recommend selectively terminating one or more fetuses. 10. Intrauterine Treatment of Fetal Conditions Intrauterine blood transfusions are relatively standard practice in some areas. Fetal surgery is still relatively uncommon. Encourage open discussions to address emotional issues and differences of opinion among staff members 11-Issues of female sterilization Is an operation to permanently prevent pregnancy. The fallopian tubes are blocked or sealed to prevent the eggs reaching the sperm Failed sterilization and the consequent wrongful pregnancy will give rise to litigation. Two aspects of sterilization failure attract litigation: Inadequate consent Defective surgery Issues of Failure – Female sterilization Spontaneous recanalization is rare. Sterilization performed without diagnosing an existing pregnancy Ligation of wrong structures(eg. Round ligament) can lead to failure where the legal threat is high. Issues of failure – Female sterilization- contd.. Ectopic pregnancy: An ectopic pregnancy is when a fertilized egg implants itself outside of the uterus, usually in one of the fallopian tubes. There is less chance for ectopic pregnancy after sterilization. Injuries to bowel, bladder or large blood vessels may complicate the procedure. Legal problems are more when sterilization is done in emergency conditions without prior counselling. 12. Contraceptives Contraceptives: A contraceptive is a device or drug that prevents a woman from becoming pregnant. Some contraceptives prevent pregnancy by preventing ovulation. Issues of Intra uterine contraceptives (IUCD): Perforation of uterus Complications of IUCD IUCD failure Oral pills Pill failure or missed pill are usual factor behind contraceptive failure. To prevent : Do - proper demonstration of pill intake. - inform the user about the minor short –term and major long –term side effects. Injectable contraceptives High incidence of amenorrhea and irregular menstruation is poorly accepted by women. Pros and cons to be informed. Free-choice should be adopted for selection of the method of contraception provided the acceptor has no contraindications.  13. Infertility and Assisted Reproductive Technology (ART) Is used to treat infertility. It includes fertility treatments that handle both eggs and sperm. It works by removing eggs from the ovaries. The eggs are then mixed with sperm to make embryos.  The couple should be informed about need maximum physical, mental and financial contribution. and they should be explained about the different methods of treatment applicable to them with the success rates and possible hazards. It involves many issues like : Donor insemination IVF Egg freezing Storing of embryos Embryo research Surrogacy. Donor insemination raises the issue whether the child should be told about his genetic father or not. Ethics changes from time to time keeping pace with changing social values, the surrogacy issue being example.  What are the pros and cons of using unused embryos for medical research? Is there anything wrong with disposal of unused embryos…leaving them on the counter to unthaw and degenerate? What if the surrogate decide to keep the baby? What if the surrogate with genetic ties demands to visit her child?  Who should make a decision to unthaw frozen embryos? Is handing over a child after delivery for a fee “baby selling”? Is it wrong for a surrogate to abort?  13. Human reproductive cloning involves the creation of individuals that contain identical sets of nuclear genetic material (DNA). Is human reproductive cloning possible? There currently is no solid scientific evidence that anyone has cloned human embryos. Because the risks associated with reproductive cloning in humans introduce a very high likelihood of loss of life, the process is considered unethical.