Bioethical Consideration of Maternal-Fetal Issues - Case Study Example

Ethical Issue: Bioethical Consideration of Maternal-Fetal Issues “Pregnant Women and Cervical Cancer: Balancing Best Interest of Mother and Fetus” Name Institution Ethical Issue: Bioethical Consideration of Maternal-Fetal Issues “Pregnant Women and Cervical Cancer: Balancing Best Interest of Mother and Fetus” In circumstances that challenge an individual’s ethical principles and values, identifying the conflicting values is vital to attain a desirable solution. The fundamentals of clinical and medical ethics involve five factors. Autonomy is the first factor. Consideration of autonomy implies that the patient has to give his or her perspective on all medical cases before an expert proceeds to offer service to him or her. The second aspect is veracity, which entails disclosure of all relevant information to all the concerned parties. The third factor is beneficence. Beneficence involves the medical practitioners doing well in what they feel is the best for the patients. Another component of the ethical fundamentals is non-maleficence. Non-maleficence gives a guideline that the medical personnel should not harm the patient. The last part of the basics of medical ethical practice is justice, which means that the doctors and other medical personnel should always be fair to all the patients (Killion & Dempski 2010, p. 37). Prenatal Health Care: The Case Study Summary of Case Mrs. Smith reached the clinic about 30 minutes late and found Patty, the nurse at the reception desk. She was in the company of her adolescent son and her 10-year-old daughter. The nurse realized that she was pregnant and, as a result, the she had gone to the clinic for a prenatal checkup. Dr. Daniels had a quick look at Mrs. Smith’s chart before inviting her patient into the exam room. The doctor realized that the patient had stayed too long before having a medical checkup, for this case, ten years. During the interview, Dr. Daniels discovers that her patient’s pregnancy was important to her relationship with her new husband. Mrs. Smith was excited about the pregnancy because she was expectant of her first child to her new husband. The doctor learned that the client had not attended her clinics because she was jobless and did not have a medical cover (Bowes 2007, p. 1). The doctor finished the interview and informed Mrs. Smith that on that day, she would perform a pap smear and draw some blood for urinalysis along with her client’s examination. Dr. Daniels also informed her client that she would schedule an ultrasound to enable her determine the correct age of her pregnancy and when she should expect her newborn. The doctor asked Mrs. Smith if she had any questions, which the patient replies that she was content. While in the physical exam room, the doctor discovers that her patient had several lesions in her cervix, which prompted her to tell of the problem. The doctor told her client that she needed to biopsy the sites in addition to the Pap smear. A week after her initial visit, Mrs. Smith revisited the clinic for the biopsy, which indicated evidence of abnormal cells in her cervical walls. She was shocked to receive the news and proceeded to ask the doctor about the possible effects on her fetus. In response, Dr. Daniels informed her patient that if the symptoms were in their early stages of development, then the doctors should advice that the patients carry the pregnancy to delivery. On the contrary, Dr. Daniels told Mrs. Smith that if the condition was in the late developmental stage, there was a necessity for hysterectomy for treatment of cancer. Interpretation of the Case In Relation To Medical Ethics According to the case, the patient was uncertain of her pregnancy period; she could only guess that she was five months pregnant. The case does not indicate the findings of the ultrasound tests that Dr. Daniels performed. For the purpose of this interpretation, I will assume that the gestation period was 20 months. There is also news that the patient had stage II cancer, which meant that it needed treatment. From the assessment of her marital life, it is clear that the patient’s pregnancy was critical to her new husband. Currently, doctors advice all women with stage II cervical cancer to begin treatment as soon as possible (Getz & Kirkengen 2003, p. 4). There are two possible modes of treatment, radiation, and hysterectomy. Whichever the method used, the result is the death of the fetus, which implies that if the Smiths decided on any form of treatment, then they risk the loss of the child. Another complication would be that Mrs. Smith would lose her ability to become pregnant in the future. There is an alternative that the Smiths can postpone the treatment until they receive their baby-to-be. There are provisions in the law that Mrs. Smith could terminate the pregnancy for medical reasons either during or after the cancer treatment. The case indicates the respect for autonomy as the central ethical issue in relation to medical practice (Post, 1996).. The physicians and other givers of healthcare need to support patients in terms of decision-making. If the medical practitioner, Dr. Daniels had to show respect for autonomy, then she was required to give her patient enough information concerning the case. For this case, the patient needed to have information relating to the advantages and disadvantages of the treatment and the alternatives for the treatment. Giving non-directive counseling proves a difficult task. Most patients are likely to make decisions basing on what information the doctor stresses most. In most cases, the physicians make decisions basing on their personality. For instance, the doctor may decide to advise Mrs. Smith against the treatment because she believes in the protection of the life of the unborn. For this reason, it is important that the doctor strikes balance between the pressing issues of any case. For Mrs. Smith’s case, the doctor should think of the interest of the smiths in the newborn and the possible effects of the medication on the mother’s mortality. The dilemma of counseling, in this case, is complicated by the fact there is little evidence of the effects of delaying treatment of stage II cervical cancer for neonatal viability. The existing evidence only involves the early phases of the same disease. The Smiths may also consider chemotherapy followed by definitive therapy accompanied by radiation or radical surgery during the pregnancy (Getz & Kirkengen 2003, p. 2). The reason for the use of such diagnostic procedures is to minimize the metastatic cancer spread during the pregnancy period while awaiting treatment. If the patient were to receive the best guidance, then the doctor should inform her to wait until she delivers her baby. The rationale a decision such as this one is the few proven cases of survival relating to the first stage of cervical cancer. The doctors may also decide to counsel the patient basing on the cautionary motives. The doctor may decide not to take risks and save the life of the patient at the expense of the fetus because there is no prove of loss of the fetus. Should the patient decide to delay the treatment, she would face another decision, which she must make by her and her healthcare personnel. That decision would still weigh the benefits of her infant against her health. Some medical staff may recommend the delivery of the child as soon as the lungs indicate the earliest signs of maturity in an attempt to shorten the delayed treatment (Pinkerton & Finnerty 2009, p. 3). Such a decision also has the challenge of developing respiratory complications for the children born before 40 months of gestation. A final ethical concern for the case is the tendency of some of the doctors to object to some decisions, which the patient might make informally. For such reasons, the doctors will exercise their professionalism and determine the best for the patients. The four issues of medical ethics apply to this case for the best of the fetus and the mother. The doctors need to tell the patient the truth of the medical procedures, be fair to the lives the baby and its mother, and maintaining professionalism as directed by beneficence. The patients have the right to receive no harming procedures from the doctors as directed by maleficence. Conclusion Ethical principles of practice in medicine and related fields support the idea of establishing a balance between the genuine medical cases and the patient’s’ requisitions. The medical practitioners should understand the situations, which warrant compromising treatment procedures, such as cases cervical cancer for pregnant women. Medical doctors need to observe the ethical concerns of the diagnostic procedures. Such issues may include respect for the patients’ autonomy for cases that medical concerns differ with what the patient requires. The doctors also need to consider maintaining veracity in the process of discussions with patients. Ethics also direct the medical personnel to maintain beneficence and maleficence in the process of making decisions concerning the patients. The physicians should also consider justice and fairness in their medical practices. For such cases, there is a clear indication that the medical doctors and the patients have varied roles to play in the ethics medical care for pregnant women.   Bibliography Bowes, W. A. (2007). Pregnant Women and Cervical Cancer: Balancing Best Interest of Mother and Fetus. Virtual Mentor: American Medical Association Journal of Ethics, 9(9), 600-604. Retrieved January 29, 2015 from http://virtualmentor.ama-assn.org/2007/09/pdf/ccas1-070s9.pdf Getz, L., & Kirkengen, A. L. (2003). Ultrasound Screening In Pregnancy: Advancing Technology, Soft Markers for Fetal Chromosomal Aberrations, And Unacknowledged Ethical Dilemmas. Social Science & Medicine, 56(10), 2045-2057. Killion, S. W., & Dempski, K. (2006). Legal and Ethical Issues. Sudbury, Mass, Jones and Bartlett. Pinkerton, J. V., & Finnerty, J. J. (2009). Resolving The Clinical And Ethical Dilemma Involved In Fetal-Maternal Conflicts. American Journal of Obstetrics and Gynecology, 175(2), 289-295. Post, L. F. (1996). Bioethical Consideration of Maternal-Fetal Issues. Fordham Urban Law Journal, 24, 757. Read More