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ETHICAL ISSUES in OBSTETRICS and GYNECOLOGY by the FIGO Committee for the Study of Ethical Aspects of Human Reproduction and Women’S Health

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ETHICAL ISSUES in OBSTETRICS and GYNECOLOGY by the FIGO Committee for the Study of Ethical Aspects of Human Reproduction and Women’S Health ETHICAL ISSUES IN OBSTETRICS AND GYNECOLOGY by the FIGO Committee for the Study of Ethical Aspects of Human Reproduction and Women’s Health OCTOBER 2012 FIGO Published by FIGO FIGO House Waterloo Court, Suite 3 10 Theed Street London SE1 8ST United Kingdom Tel: + 44 20 7928 1166 Fax: + 44 20 7928 7099 Website: www.FIGO.org ETHICAL ISSUES IN OBSTETRICS AND GYNECOLOGY by the FIGO Committee for the Study of Ethical Aspects of Human Reproduction and Women’s Health OCTOBER 2012 FIGO CONTENTS FOREWORD 5 GENERAL ISSUES IN WOMEN’S HEALTH AND ADVOCACY 1. The role of the Ob/Gyn as an advocate for women’s health 1999 8 2. Violence against women 2007 9 3. Sex selection for non-medical purposes• 2005 10 4. Ethical framework for gynecologic and obstetrical care 2007 12 5. Guidelines regarding informed consent 2007 13 6. The ethical aspects of sexual and reproductive rights 1997 15 7. Some ethical issues in the doctor patient relationship 1997 16 8. Ethical guidelines in regard to terminally ill women 1999 17 9. Confidentiality, privacy and security of patients’ health care information 2005 19 10. Female genital cutting• 2006 22 11. Ethical guidelines on conscientious objection 2005 25 12. Professional obligation to fellow obstetricians and gynecologists• 2006 28 13. Harmful stereotyping of women in health care 2011 28 14. Adolescent youth and reproductive health care and confidentiality 2008 32 15. HPV vaccination and screening to eliminate cervical cancer 2007 35 16. Just inclusion of women of reproductive age in research 2008 36 17. Disclosing adverse outcomes in medical care 2010 37 18. Cross border reproductive services 2012 39 19. Brain drain of healthcare workers 2009 41 ISSUES IN GENETICS AND EMBRYO RESEARCH 1. Human cloning 2005 45 2. Patenting human genes 1997 46 3. Embryo research 2005 47 4. Ethical guidelines on the sale of gametes and embryos 1997 49 5. Ethical guidelines regarding altering genes in humans 1997 49 6. Donation of genetic material for human reproduction 2007 52 •These statements are the result of careful research and considered discussion between the FIGO Committee for the Ethical Aspects of Human Reproduction and Women’s Health and the FIGO Committee for Women’s Sexual & Reproductive Rights. 1 FIGO 7. Guidelines for use of embryonic or fetal tissue for therapeutic clinical applications 2007 56 8. Testing for genetic predisposition to adult onset disease 2001 57 9. Ethical guidelines concerning cytoplasmic animal human hybrid embryos 2008 59 10. Professional obligations related to developments in genomics and proteomics in human testing 2008 60 ISSUES IN CONCEPTION AND REPRODUCTION 1. Ethical guidelines on multiple pregnancy 2005 62 2. Ethical aspects of gamete donation from known donors 2000 64 3. Surrogacy 2007 67 4. Prenatal diagnosis and screening 2012 70 5. Ethical aspects of HIV infection and reproduction 2012 73 6. HIV and fertility treatment 2012 75 7. Ethical considerations with oocyte and ovarian cryopreservation in women 2005 77 8. Ethical guidelines on iatrogenic and self-induced infertility 2006 79 9. Fertility centres and whom they should treat 2008 82 10. Uterine transplantation 2008 83 PREGNANCY AND MATERNAL/FETAL ISSUES 1. Brain death and pregnancy 2011 85 2. Ethical aspects regarding Caesarean delivery for non-medical reasons 1998 88 3. Ethical guidelines regarding interventions for fetal well being 2011 89 4. Definition of pregnancy 1998 90 5. Ethical issues in the management of severe congenital anomalies 2012 91 6. Ethical aspects concerning termination of pregnancy following prenatal diagnosis 2007 93 7. Anencephaly and organ transplantation 2007 97 8. Safe motherhood 2012 98 9. Ethical guidelines on obstetric fistula 2006 100 10. Pregnancy and HIV-positive patients 2008 103 11. Planned home birth 2012 106 12. Task-shifting in obstetric care 2012 109 2 FIGO ISSUES REGARDING NEONATES 1. Ethical guidelines on cord blood banking 2012 112 2. Resuscitation of newborns 2006 114 3. Ethical aspects in the management of malformed newborn infants 1997 117 4. Ethical aspects concerning neonatal screening 2008 120 ISSUES IN CONTRACEPTION AND ABORTION 1. Female contraceptive sterilization 2011 122 2. Ethical issues in the management of severely disabled women with gynaecological problems 2011 126 3. Ethical considerations respecting the use of antiprogestins 1994 128 4. Ethical aspects of the introduction of contraceptive methods for women 1997 129 5. Ethical aspects of induced abortion for non-medical reasons 1998 130 6. Guidelines in emergency contraception 2002 133 7. Ethics in family planning 2008 134 ISSUES IN ADVERTISING & MARKETING HEALTH SERVICES 1. Ethical background for advertising & marketing 2003 136 2. Guidelines for physicians’ relationships with industry 2003 137 3. Recommendations for medical information and advertising on the web 2003 138 ETHICAL ISSUES IN MEDICAL EDUCATION 1. Ethical issues in medical education: gifts and obligations 2005 2. Guidelines on ethical issues involved in the advertising of credentials and education 2003 NEW, UPDATED OR REPLACED GUIDELINES SINCE 2009 1. Harmful stereotyping of women in health care 2011 28 2. Disclosing adverse outcomes in medical care 2010 37 3. Cross border reproductive services 2010 39 4. Brain drain of health care worker 2008 41 5. Prenatal diagnosis screening 2012 70 6. Ethical aspects of HIV infection and reproduction 2012 73 7. HIV and fertility treatment 2012 75 8. Brain death and pregnancy 2011 85 3 FIGO 9. Ethical guidelines regarding interventions for fetal well being 2011 89 10. Ethical issues in the management of severe congenital anomalies 2012 91 11. Safe motherhood 2012 98 12. Planned home birth 2012 106 13. Task-shifting in obstetric care 2012 109 14. Ethical issues in cord blood banking 2012 112 15. Female contraceptive sterilization, 2011 122 16. Ethical issues in the management of severely disabled women with gynecological problems, 2011 126 4 FIGO FOREWORD Obstetrics and Gynecology, as it deals with all of life’s major passages – birth, reproduction, aging, and death – has seen every major medical advance create unexpected ethical dilemmas for our discipline. The moral dilemmas that face Obstetrics and Gynecology range from public advocacy for the very basic needs of health and human rights for women to the most intricate issues surrounding the growing knowledge and use of the human genome. In 1985 FIGO set up the Committee for the Study of Ethics in Human Reproduction and Women’s Health. The main objectives of the Committee focus on recording and studying the general ethical problems which emanate from research and practice in women’s health as well as bringing these issues to the attention of physicians and the public in developed and developing countries. From the time of its inception, the Committee has made recommendations for the guidance and to stimulate discussion for all practitioners, and particularly for use by member societies to stimulate broader national and regional discussions on vexing ethical issues. All of the recommendations may be published, translated and circulated provided the initial explicatory introduction is included (see page 7) and due acknowledgement is given. There is no copyright against publication. Gamal I. Serour Membership in the Committee from 2009–2012: B. Dickens – Chair (Canada), F. Shenfield (UK), J. Milliez (France), D. Shah (India), A. F. M. Ebrahim (South Africa), J. C. Vargas (Colombia), Y. F. Wang (China) Consultants: J. Cain (USA), Lord Patel (UK) Ex Officio: H. Rushwan (Sudan) Membership in the Committee from 2006–2009: J. Milliez – Chair (France), B. Dickens (Canada), G. Serour (Egypt), F. Shenfield (UK), Ching-Li Hu (China) A. Martínez Palomo (Mexico), K. Rao (India) Consultant: J. Cain (USA) 5 FIGO Membership in the Committee from 2003–2006: G. Serour – Chair (Egypt), J. Milliez (France), B. Dickens (Canada), J. Cain (USA), S. McLean (UK), R. A. Ramos (El Salvador), F. Shenfield (UK) Membership in the Committee from 2000–2003: J. Cain – Chair (USA), J. G. Schenker (Israel), G. Serour (Egypt), J. Barzelatto (USA), M. I. Plata (Colombia), M. Hansotia (India), S. Arulkumaran (UK), J. Milliez (France), S. McLean (UK), A. Faundes (Brazil), R. A. Ramos (El Salvador) Membership in the Committee from 1997–2000: J. M. Cain – Chair (USA), J. G. Schenker (Israel), G. Serour – (Egypt), P. Dunn (UK), M. Liljestrom (Finland), J. Barzelatto (USA), I. S. Plata (Colombia), M. Hansotia (India), S. Arulkumaran (UK) Membership in the Committee from 1994–1997: J. G. Schenker – Chairman (Israel), L. Andolsek (Slovenia), P. Baird (Canada), J. Cain (USA), P. Dunn (UK), M. Liljestrom (Finland), H. Ludwig (Switzerland), C. Macnaughton (UK), F. Manguyu (Kenya), R. Nicholson (Argentina), I. S. Plata (Colombia), R. S. Samil (Indonesia), S. Sheth (India), G. Serour (Egypt) Observers: J. Barzelatto (USA), M. Fathalla (Egypt), J. J. Sciarra (USA) Membership in the Committee from 1985–1994: C. Sureau – Chairman (France), F. Beller (Germany), R. Cook (Canada), P. Correa (Senegal), J. Dionisi (Argentina), P. Dunn (UK), M. Fathalla (Egypt), H. Hathout (Kuwait), L. Lampe (Hungary), J. Lauritsen (Denmark), S. Michalas (Greece), S. Sakamoto (Japan), B. Saxena (India), J. G. Schenker (Israel), J. J. Sciarra (USA) 6 FIGO FIGO Committee for the Ethical Aspects of Human Reproduction and Women’s Health Committee Statement to be used when publishing the enclosed Ethical Guidelines Introduction The FIGO Committee for the Ethical Aspects of Human Reproduction and Women’s Health considers the ethical aspects of issues that impact the discipline of Obstetrics, Gynecology and Women’s Health. The following documents represent the result of that carefully researched and considered discussion. This material is intended to provide material for consideration and debate about these ethical aspects of our discipline for member organizations and their constituent membership. 7 FIGO GENERAL ISSUES IN WOMEN’S HEALTH AND ADVOCACY THE ROLE OF THE OB/GYN AS AN ADVOCATE FOR WOMEN’S HEALTH 1. Obstetricians-Gynecologists have an ethical duty to be advocates for women’s health care.
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