Patient choice: Maternal-fetal conflict
| Autor: | Elena Gates, J. Lee Dockery, LeRoy Walters, Kenneth J. Ryan, Judith J. Stark, Frederick R. Abrams, Albert R. Jonsen, William B. Well, Sherman Elias, Mark I. Evans |
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| Rok vydání: | 1990 |
| Předmět: |
Gynecology
medicine.medical_specialty Fetus Health (social science) business.industry Patient choice Public Health Environmental and Occupational Health Obstetrics and Gynecology Health technology medicine.disease Substance abuse Obstetrics and gynaecology Medical advice Maternity and Midwifery Health care Fetal distress Medicine business Intensive care medicine reproductive and urinary physiology |
| Zdroj: | Women's Health Issues. 1:13-15 |
| ISSN: | 1049-3867 |
| DOI: | 10.1016/s1049-3867(05)80006-4 |
| Popis: | W'ith the increasing development of medical technology in perinatal medicine, the fetus has become more accessible to diagnostic procedures and treatment. The maternal-fetal relationship remains a unique one, as the pregnant woman and the fetus are two patients with access to one through the other. The welfare of the fetus is of the utmost importance to the majority of women; thus only rarely will a conflict arise. Two situations in which maternal and fetal interests can be potentially divergent are 1) the pregnant woman may refuse a diagnostic procedure, medical therapy, or a surgical procedure that may enhance or preserve fetal well-being, and if denied may result in fetal morbidity or mortality; and 2) the pregnant woman's behavior with respect to her health or life-style may be deleterious to the fetus. The following discussion is intended to clarify these issues and provide guidance to the obstetrician. The obstetrician should be concerned with the health care of both the pregnant woman and the fetus within her, assessing the attendant risks and benefits to each during the course of care. The pregnant woman also has concerns for herself and her child and evaluates the risks and benefits presented to her from her own sense of values. The aim of medicine is always to foster the greatest benefit with the least risk. Risks and benefits, however, may be valued differently by the pregnant woman and the obstetrician, creating the potential for conflict. When a pregnant woman is healthy but the fetus may be in danger, the pregnant woman is often asked to consent to diagnostic procedures or therapy for the sole benefit of the fetus. Examples of this might be a cesarean delivery for fetal distress or intrauterine surgical correction of a congenital defect. The second area of potential conflict includes problems of the pregnant woman's behavior with regard to a complicating illness or her life-style, which may jeopardize the fetus. Examples of such behavior might be failure to take insulin in diabetes meUitus or failure to follow a diet in phenylketonuria. The pregnant woman's life-style may endanger the fetus, for example, by substance abuse. In summary, the pregnant woman may not cooperate in medical care designed for the benefit of the fetus, or she may create a potentially hazardous environment for the fetus. The mechanism of responding to the patient's failure to cooperate with medical advice in these situations should be for the obstetrician to convey the reasons for the current recommendations to the pregnant woman, encouraging responsible behavior through education and counseling. Medical knowledge and judgment have limitations and fallibility, which the obstetrician must recognize when assigning clinical risks and benefits in order to advise patients. Methods for detecting fetal distress or deterioration are not always reliable indicators of poor outcome; therefore, assigning a deCommittee Opinion from the Committee on Ethics |
| Databáze: | OpenAIRE |
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