Ethics in obstetrics and gynaecology Dr Lisa Joels MD FRCOG Royal Devon & Exeter NHS Trust November 2011 © Royal College of Obstetricians and Gynaecologists

Principles of medical ethics Beneficence – Do good Non-maleficence – Do no harm Autonomy – Respect the choices of the individual Justice – Fairness, no discrimination

Types of ethics Duty based ethics – Where conscience and motive are paramount – “Good cannot come from evil” – Often related to religion or culture Goal based ethics – No action is inherently right or wrong, it depends on the consequences – “The end justifies the means” Human rights

A Doctor’s ethics A doctor cannot be forced to act against their duty based ethics – E.g. Cannot be forced to participate in termination of pregnancy A doctor should not allow their ethical beliefs to affect patient care – Refer on to colleague with different ethical views for second opinion

Ethics in O&G Refusal of blood products by Jehovah’s Witnesses – Advance directive, witnessed and carried in handheld notes – Discussed in antenatal clinic Mental Capacity Act 2005 – a patient with capacity may make their own decision even if it is “unwise”

Ethics in O&G Termination of pregnancy Contraception A doctor cannot be forced to provide these services but must provide any other care needed for these women – E.g. Evacuationfor retained products after TOP – E.g. PID following insertion of IUCD

Termination of pregnancy Legal in UK – Up to 24 weeks where risk to psychological or physical wellbeing of women or her existing children – Any gestation if risk to woman’s life or severe abnormality of fetus Linked with ethics of antenatal screening Gender selection

Ethics & the exam If a scenario is presented where termination is one option, even if your personal ethics would prevent you from providing this, you must address it in your answer – Consider saying you’d arrange for her to see a colleague because of your conscientious objection

Further reading General Medical Council – Ethical guidance RCOG – Ethical guidelines – Greentop guideline 47 – Blood transfusion in obstetrics BMA