Ethical Decision-Making: the Grey Area When Pregnancy and Medical Conditions Collide Essay

Investigation of four case studies linked on the common ground of pregnancy, medical conditions affecting the fetus or mother and the decision to terminate pregnancy have been explored through various perspectives and avenues - Ethical Decision-Making: the Grey Area When Pregnancy and Medical Conditions Collide Essay introduction. The application of ethics throughout one’s daily life is essential; ensuring ethics of the highest standards are in place when dealing with the health, well-being and quality of an individual life are vital to render humanity. Discussed are concepts involving the quality of care an ethical doctor should provide, bioethical principals, ethics of abortion and a survey depicting results concerning doctor ethicality.

Ethical and legal dilemmas concerning doctor and patient decisions are discussed in depth and compared to medical ethical values and laws. Analyzed are laws and terms applicable amidst such a discerning decision with many factors contributing to such a delicate situation. Thesis: Medicine and technology have advanced significantly in recent years; analyses of medical ethics and specific circumstances have led to questionable practice and dubious ethical dilemmas. The decision to terminate a pregnancy, in most cases, can be attributed to the use of pre-natal diagnosis.

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Amniocentesis is used to indicate a fetal abnormality and the likelihood of severe handicap, in which case a mother may choose to terminate the pregnancy. This issue is not the issue at hand, however, this particular issue lies within cultures striving for a male dominated population using a medical procedure to discover the sex of an unborn child and aborting female fetus’. Discussed in detail will be specific events and laws regarding the abuse of amniocentesis.

Along the same lines of antenatal diagnosis will be the case study involving six twin pregnancies discordant for fetal cardiac disease (Malhotra, Menahem, Shekleton, & Gillam, 2009). Medicine and technology have advanced significantly in recent years leading to the analysis of medical ethics and specific circumstances presenting dubious ethical dilemmas. Also discussed will be the case study of Mary who was in remission of cancer and wished to become pregnant (Emanuel, & Powderly, 1994). Contrary to the case studies mentioned above, the dilemma here is not the fetus life, but it is the ealth of the mother. Along the same lines of this dilemma is a case in which attorneys are currently seeking to employ rigid protocols and safer medications related to the Epilepsy drug, Topamax or Topiramate (Monheit, 2011). Many factors influence the ethical decision and legal means of care when pregnancy and medical conditions coincide. The word “ethics” can be applied in many different aspects throughout life. Success at any rate is greatly contributed to a decision placed upon a person in an unusual circumstance where specific rules do not apply.

The American Heritage Dictionary has defined ethics as: “The study of general nature of morals and of specific moral choices; moral philosophy; and the rules or standards governing the conduct of the members of a profession. ” Specifically discussed will be the ethics, principals, values and morals physicians are expected to use when caring for patients in any case and more specifically cases involving pregnancy and medical conditions. In medical cases, bioethical principals are described as the following: autonomy, beneficence, non-malfeasance and justice.

Decision-making concerning medical and ethical considerations will be explored in depth. Paralleled with ethical obligation are equally important litigation procedures. Discussed will be laws enacted to protect the human right of choice as well as the right for a pregnant woman to work. The controversy involving fetal rights will be grazed. The main dilemma will not be focused on the legality of abortion itself, but on the decision to set limits when it comes to pregnancy and medical conditions.

This decision should be reached after assessing bioethical principals, legality and more importantly the patients needs balanced with the patients diagnosis. In February of 1985 the World Congress on Law and Medicine discussed the issue of prenatal diagnosis. In New Delhi, India doctors and lawyers set out to determine if amniocentesis and other diagnostic procedures were being used to weed out female infants so as to promote a male-dominated society. The procedure was intended to diagnose sex-linked disorders and the likelihood of severe handicap (Dickens, 1986).

During discussion, some urged that the procedure be made illegal. Bernard Dickens, Professor in the faculty of Law and Faculty of Medicine addresses the flip-side of the ethical dilemma in the following statement, “Describing amniocentesis as nothing more than a search and destroy mission directed against unwanted fetuses, these participants felt that the procedure had no legitimate use, and was a means only of medical abuse. ” An alternative approach consists of keeping the sex from the parent and only disclosing the information of the sex if a male affected by the sex-linked disorder.

If the fetus were found not affected, the sex would not be disclosed. Patients have a right to information gained through the procedure, and some physicians see this approach as ethically ambivalent (Dickens, 1986). The ethical dilemma exists when commentators in the developed world have neglected to inform the population affected (Dickens, 1986). Professor Bernard Dickens explains, “When a family already has several female children and no son, the birth of another daughter may threaten intolerable social and economic stress.

Sex-based abortion may be preferable to the birth of a child destined to be abandoned or to die from neglect or starvation. ” The World Congress on Law and Medicine concluded that abortion of female fetus without defect would be chargeable with professional misconduct, and “would face the severest sanctions permitted by law” (Dickens, 1986). Ethical perspective has been developed in societies of different cultural beliefs and these beliefs should be interpreted and understood before judging another belief systems ethicality.

Most would agree to the belief that medical practices used to diagnose prenatal defects should not be used for the sole reason of aborting female fetuses. However, taking a standpoint from a different ethical culture is eye-opening as Dickens points out. Is it ethical to abort a fetus because she is female? Is it ethical to continue with a pregnancy with knowledge of likely neglect and starvation in the child’s future? A global mandated boundary prevents the termination of an unwanted pregnancy, and instead sentences a child to suffer through an unwanted life.

Where is the human right in that? In research, another avenue of ethicality would be the flip side of the spectrum: Impregnating a woman diagnosed with cancer. Human rights are defined as “an inherent dignity with equal and inalienable rights as the foundation of freedom, justice, and peace in the world” (Ferrell, Ferrell, & Fraedrich, 2011). The U. S. Supreme court issued Article 25 to ensure a standard of living and special rights to those who are pregnant (Ferrell, Ferrell, & Fraedrich, 2011 pg 422).

Article 25 applies to the next case study of Mary who wishes to become pregnant. She is thirty-five-years-old and was diagnosed with cancer five years ago, against gynecologist cautions of ever becoming pregnant, Mary and her husband Jason would like to have a child (Emanuel, & Powderly, 1994). Mary is pre-menopausal and would require fertility treatment to achieve pregnancy. The situation concerns the infertility specialist because she is not certain of the patients understanding of recurring cancer and the uncertainties involved in hormone treatments.

The question at hand is this, “Should the infertility clinic accept them as clients? ” The freedom of choice should deem this answer to be yes, however the decision to impregnate a women with cancer tests the ethical and legal liability of the doctor. In the name of autonomy—“the respect for the individual and their ability to make decisions with regard to their own health and future” (Green, 2001), the doctor assesses the patient, Mary and come to an understanding of all possible risks.

The physician must take proper measures to educate the parents for liability and ethical reasons. The physician should evaluate both personal and professional values, ethics and policies to reach a decision. Some have argued that terminal illness should be reason for women not to reproduce. The patient faces great risks and difficult personal decisions. An ethical doctor should consider the patients human right to become pregnant, but not without honoring professionalism first.

While the infertility specialist concerns are valid, it should ultimately be Mary’s decision to become pregnant. Basic ideas on medical ethics are not so different from those in the business world, the difference is the customer base and the stakes are similar in that an incompetent doctor could cause equally distressing damage as that of Madoff. In a survey of UK and US doctors’ aimed to determine ethical and professional values, the following statement was made, “…some doctors would rather overlook the incompetence of a colleague than make themselves uncomfortable.

Nearly 20 percent of doctors in Britain and about 17 percent of doctors in this country said they had dealt with an ‘impaired or incompetent’ doctor in the last three years” (O’Conner, 2011). Madoff successfully pulled of a Ponzi scheme—bringing in as much as $250,000 a day until he was discovered in 2008 (Ferrell, Ferrell, & Fraedrich, 2011). Madoff ‘s white-collar crime destroyed $65 billion in investments, led to a sentence of 150 years in prison, and led Madoff’s oldest son to kill himself because of the allegations (Ferrell, Ferrell, & Fraedrich, 2011). Similar situations of medical fraudulence could result in similar results.

Medical ethics are in place to prevent mal-practice, fraud and proper care. Medical ethics is “primarily a field of applied ethics, the study of moral values and judgments as they apply to medicine” (Talukder, 2010) The history of medical ethics goes back before the 4th century BC when Hippocrates formulated the Hippocratic Oath (Talukder, 2010) Values in medical ethics consist of the following taken from the Bangladesh Journal of Medical Science, 2010: •Autonomy- the patient has the right to choose or refuse treatment •Beneficence- physician should act in the best interest of the patient •Non-malfeasance- “first, do no harm” Justice- concerns the distribution of resources and the decision of fairness and equality regarding who gets what treatment •Truthfulness and honesty- the concept of informed consent These are all characteristics to consider when dealing with a medical ethical dilemma. The World Health Organization (WHO) described an ethical dilemma as “a dilemma between different values which are seen as important or beneficial, but which in particular cases and circumstances are in conflict with each others” (Talukder, 2010).

As with any business, a code of ethics must be formally established so as to set the expectation of what standards are in place. Although there are many variations and versions, the Hippocratic oath has been used for centuries to express medical values in the Western medical profession (Geraghty, 2000). The original oath, taken from a medical article on bioethical principals written by Dr.

Ben Green is as follows: I SWEAR by Apollo the physician and Aesculapius, and Health, and All-heal, and all the gods and goddesses, that, according to my ability and judgment, I will keep this Oath and this stipulation to reckon him who taught me this Art equally dear to me as my parents, to share my substance with him, and relieve his necessities if required; to look upon his offspring in the same footing as my own brothers, and to teach them this art, if they shall wish to learn it, without fee or stipulation; and that by precept, lecture, and very other mode of instruction, I will impart a knowledge of the Art to my own sons, and those of my teachers, and to disciples bound by a stipulation and oath according to the law of medicine, but to none others. I will follow that system of regimen which, according to my ability and judgment, I consider for the benefit of my patients, and abstain from whatever is deleterious and mischievous. I will give no deadly medicine to any one if asked, nor suggest any such counsel; and in like manner I will not give to a woman a pessary to produce abortion.

With purity and with holiness I will pass my life and practice my Art. I will not cut persons labouring under the stone, but will leave this to be done by men who are practitioners of this work. Into whatever houses I enter, I will go into them for the benefit of the sick, and will abstain from every voluntary act of mischief and corruption; and, further, from the seduction of females or males, of freemen and slaves.

Whatever, in connection with my professional service, or not in connection with it, I see or hear, in the life of men, which ought not to be spoken of abroad, I will not divulge, as reckoning that all such should be kept secret. While I continue to keep this Oath unviolated, may it be granted to me to enjoy life and the practice of the art, respected by all men, in all times. But should I trespass and violate this Oath, may the reverse be my lot. A lot has changed since around 400 B. C. Medical advances provide options that would not otherwise be available.

Because of the rapid rate of improvement, the following oath has been adjusted to fit today’s culture and capability; it has been approved by the American Medical Association: You do solemnly swear, each by whatever he or she holds most sacred That you will be loyal to the Profession of Medicine and just and generous to its members That you will lead your lives and practice your art in uprightness and honor That into whatsoever house you shall enter, it shall be for the good of the sick to the utmost of your power, your holding yourselves far aloof from wrong, from corruption, from the tempting of others to vice That you will exercise your art solely for the cure of your patients, and will give no drug, perform no operation, for a criminal purpose, even if solicited, far less suggest it That whatsoever you shall see or hear of the lives of men or women which is not fitting to be spoken, you will keep inviolably secret These things do you swear. Let each bow the head in sign of acquiescence And now, if you will be true to this, your oath, may prosperity and good repute be ever yours; the opposite, if you shall prove yourselves forsworn (Green, 2001).

Similarly, both versions indicate that as a professional working in the medical field one should strive to put forth every effort to honorably exercise skill in his or her medical field. In contrast, the original version states, “I will give no deadly medicine to any one if asked, nor suggest any such counsel; and in like manner I will not give to a woman a pessary to produce abortion. Eric Cassell identified with the medical ideals within the last generation with the following statement, “We were not far into the era of modern definitions of disease – say, the middle or end of the nineteenth century – when doing good for the patient was clearly equated with doing good for the disease” (Martinsen, 2011). Dr. Ben Green explains that many medical students recite the Hippocratic oath when they graduate from med school. When faced with a sensitive subject such as abortion, the Hippocratic oath is inconsistent in the ethical liability. The subject of pregnancy termination, in any sense has created an extremely controversial grey area riddled with lawsuits, ambiguous virtues, questionable practice and many other ethical aspects physicians consider in such a risky assessment.

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