Ethics And Perinatology

The rapid development of new technology used in obstetrics and neonatology has been accompanied by new moral problems presented by the choices this technology generates. Ethics and Perinatology is a timely examination of the moral problems caused by clinical and research practices in perinatology. 14 major issues are each addressed by a leading clinician whose writing is then critically reviewed by a medical ethicist, a legal theorist, or an economist. Thus each chapter embodies the independent perspectives of international experts from different disciplines. This book offers a new approach to the presentation of ideas in medical ethics concerning obstetrics and perinatology that will benefit all physicians, nurses, philosophers, and medical ethicists, as well as the interested lay reader.

This book provides the first clinically comprehensive and practical approach to ethical challenges in perinatal medicine. The first chapter introduces and explains the professional responsibility model of perinatal ethics. The professional responsibility model is based on the medical ethics of two major physician-ethics in the history of Western medical ethics, Dr. John Gregory (1724-1773) of Scotland and Dr. Thomas Percival (1740-1804) of England. The professional responsibility model is used to articulate the ethical concept of the fetus as a patient and to operationalize the ethical principles of beneficence and respect for autonomy. The book provides practical guidance for clinical judgment and decision making with patients about the responsible clinical management of the wide range of issues encountered by perinatologists in clinical practice and research. Topics included: periviability; feticide; intrapartum management; maternal-fetal conflict; innovation for fetal benefit; research for fetal benefit; non-aggressive obstetric management; managing the transition from pregnancy to birth; destructive procedures such as cephalocentesis; critical care for the pregnant patient; home birth; patient-choice cesarean delivery; neonatal care as a trial of management; and setting limits on neonatal care on the basis of clinical judgments of futility.

This book addresses the ethical problems in maternal-fetal medicine which impact directly on clinical practice.

Advances in reproductive and perinatal medicine have given rise to difficult ethical issues. Do all women have the right to choose whether to reproduce? What is the moral status of the foetus during various stages of gestation and what obligations do parents have to the foetus during this period? In this book Carson Strong develops an ethical framework that aims to help resolve these and many other issues of concern to health professionals, policymakers and the general public.

“Over the last two decades, medical researchers have become more comfortable with the idea that serious attention must be given to ethical issues when the tests of new technologies are being designed. They have come to see that experimental trials must meet certain standards, not only of scientific rigour, but also of moral acceptability.” (Introduction) Presented by an international group of experts, the eight essays included in this volume evaluate the new technologies in fetal care and also wrestle with the new problems, often moral ones, that have accompanied techonological advancement. The opening chapters review state-of-the-art ultrasound imaging and molecular genetics and focus on the new patient—the fetus. From here, the efficacy of fetal therapy, the problem of assessing long-term viability, the ethical issues involved in both clinical practice and medical research, and the legal rights of the new patients and their parents are examined. The final chapter “Are Fetuses Becoming Children?” brings a fresh philosophical perspective to the question of a fetus’s status and rights.

During the past quarter century there has been a renaissance of interest in the use of peritoneal dialysis as the primary dialytic modality for the treatment of children with end-stage renal disease (ESRD). The development of continuous ambulatory peritoneal dialysis (APD) has facilitated the provision of prolonged dialysis to infants, children and adolescents and has provided pediatric nephrologists worldwide with a real opportunity to administer effective dialysis therapy to all patients afflicted with ESRD. It has been more than a decade since the initial publication of CAPD/CCPD in Children. In the interim, a great deal of clinical experience with patients receiving peritoneal dialysis has been accumulated and research efforts have substantially increased our understanding of the technique. Therefore, we felt that a second edition of CAPD/CCPD in Children was propitious to update the advances of the past decade.