Ethical issues in obstetrics & gynecology (in Malaysia)

1. ETHICAL ISSUES IN
OBSTETRICS AND
GYNECOLOGY
By Muhammad Halmii

2. Ethical Principles
1. Respect for Autonomy
1. Beneficence
1. Nonmaleficence
1. Justice
To take one example, in considering a case of a pregnant woman in preterm labor who refuses
admission to the hospital for bed rest or tocolytics

3. Core Discussions
-GENERAL ISSUES IN WOMEN’S HEALTH AND
ADVOCACY
-ISSUES IN GENETICS AND EMBRYO RESEARCH
-ISSUES IN CONCEPTION AND REPRODUCTION
-PREGNANCY AND MATERNAL/FETAL ISSUES
-ISSUES IN CONTRACEPTION

4. GENERAL ISSUES IN WOMEN’S HEALTH AND ADVOCACY
Sex selection for non-medical purposes
Legal approaches to sex selection for non-medical
reasons vary by country and range from no specific
regulation complete prohibition and criminalization.
The use of sex selection to avoid sex linked genetic
disabilities is generally considered justifiable on
medical grounds.
FIGO advocates that sex selection should follow
religious, ethical & national guidlenes
Female genital cutting
Female Genital Cutting (FGC), sometimes
referred to as female genital mutilation or female
circumcision, is a worldwide problem. It is
practiced in all continents of the world.
As affirmed in the FIGO resolution of 1994 in
Montreal, FGC is unethical and also violates
human rights principles.

5. GENERAL ISSUES IN WOMEN’S HEALTH AND ADVOCACY

6. ISSUES IN GENETICS AND EMBRYO RESEARCH
Human cloning Donation of genetic material for human
reproduction
No genetic material should be used for donation
without appropriate screening and quarantine, and the
formal written consent of the recipient(s), after
appropriate counselling on the implications, and full
explanation of the local legal effects. Withdrawal of
consent may be appropriate until the gametes or
embryos are used, but not after use.

7. ISSUES IN CONCEPTION AND REPRODUCTION
PLANNED HOME BIRTH
Preparation for home birth should be as comprehensive
as the circumstances allow, with clear and adequate
contingency plans for transportation where feasible to a
referral centre where properly trained and equipped
services are accessible. A clean delivery kit as
recommended by WHO should be made available
ETHICAL ASPECTS REGARDING
CAESAREAN DELIVERY FOR NON-
MEDICAL REASONS
Caesarean section is a surgical intervention with
potential hazards for both mother and child. It also uses
more health care resources than normal vaginal delivery
Physicians have the responsibility to inform and counsel
women in this matter.

9. PREGNANCY AND MATERNAL/FETAL ISSUES
ETHICAL ISSUES IN THE
MANAGEMENT OF THE SEVERE
CONGENITAL ANOMALIES
Women carrying a fetus with severe congenital
anomalies or one at high risk for long term severe
disability have the right to discuss and access a
termination of pregnancy. The decision to continue or
terminate the pregnancy should always rest with the
woman.
PREGNANCY AND HIV-POSITIVE
PATIENTS
Practitioners must ensure that they and their staff
members observe strict confidentiality of HIV-positive
patients’ information and privacy, according to ethical
standards and prevailing law
HIV-positive women should not be discouraged from
becoming pregnant. HIV treatment in pregnancy must
extend into postnatal care, to avoid treating mothers
solely as instruments to prevent HIV transmission to
babies

11. ISSUES IN CONTRACEPTION
FEMALE CONTRACEPTIVE
STERILISATION
No woman may be sterilised without her own previously
given informed consent, with no coercion, pressure, or
undue inducement by healthcare providers or institutions
If a physician or health worker is either unable or
unwilling to provide a desired method of family planning
or medical service for non-medical reasons, he or she
should make every effort to achieve appropriate referral.
ETHICS IN PREMARITAL
INTERCOURSE PLANNING
Males should share the responsibility in family
planning, but it should be noted that in reproductive
health there is a heavy burden on women. The
importance of male participation and responsibility in
the protection of women has become much greater
with the emergence of HIV/AIDS.