Laurence B. McCullough

Frank A. Chervenak

This book offers a comprehensive and clinically practical approach to ethics in the everyday practice of obstetrics and gynecology. The topics the authors address include: contraception, abortion, selective termination of multifetal pregnancies, gynecologic cancer, in vitro fertilization, surrogacy, prenatal diagnosis, fetal therapy, cephalocentisis, prematurity, HIV infection, and court ordered cesarean delivery. The issues involved in making decisions in many of these areas are a source of conflict, and lead to crisis between the physician and patient. One of the book's strengths is its emphasis on prevention and, if prevention fails, management, of the conflicts and crises which arise in these areas of medicine. The authors develop their preventative and management strategies on the basis of a framework for bioethics in the clinical setting. This framework is rigorously established and defended. The authors argue that four virtues -- self effacement, self sacrifice, compassion, and integrity -- generate the physician's obligation to protect and promote the patient's interest. They then identify the three types of patient's interests -- social role interests, subjective interests, and deliberative interests -- and they reinterpret the ethical principles of beneficence and respect for autonomy in terms of these. The concept of the fetus as patient, the physician's obligation to third parties, and the moral standing of fathers and family members are also addressed. The implications of their argument sets the stage for the discussions of prevention and management in the remaining sections of the book. Ethics in Obstetrics and Gynecology is a unique addition to the literature in both biomedical ethics and obstetrics and gynecology. It demonstrates that ethics should be regarded as an essential part of obstetrics and gynecology, and that clinical practice is incomplete without it.

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