Ethical Foundations

ETHICAL FOUNDATIONS

Obstetrician-gynecologists, as members of the medical pro-fession, have ethical responsibilities not only to patients, but also to society, to other health professionals, and to them-selves. The ethical foundations discussed in this section are based on the five ethical principles of autonomy, benefi-cence, nonmaleficence, veracity, and justice.

Patient–Physician Relationship

The welfare of the patient should be central to all considerations in the patient–physician relationship. The right of individualpatients to make their own decisions about their healthcare is fundamental (autonomy). Physicians and other health-care providers are charged with strict avoidance of discrim-ination on the basis of race, color, religion, national origin, or any other factor.

Physician Conduct and Practice

Obstetrician-gynecologists must deal honestly with pa-tients and colleagues at all times (veracity). This includes avoiding misrepresentation of themselves through any form of communication and maintaining medical competence through study, application, and enhancement of skills. Anybehavior that diminishes a physician’s capability to practice, such as substance abuse, must be immediately addressed. The physi-cian should modify his or her practice until the diminished capacity has been restored to an acceptable standard to avoid harm to patients (nonmaleficence). Physicians are ob-ligated to respond to evidence of questionable conduct or unethical behavior by other physicians through appropriate procedures established by the relevant organization.

Avoiding Conflicts of Interest

If potential conflicts of interest arise, physicians are ex-pected to recognize these situations and deal with them through public exposure. Conflicts of interest should be re-solved in accordance with the best interest of the patient, respect-ing a woman’s autonomy to make healthcare decisions. Thephysician should function as an advocate for the patient.

Professional Relations

The obstetrician–gynecologist’s relationships with other physi-cians, nurses, and healthcare professionals should reflect fairness, honesty, and integrity, sharing a mutual respect and concern for the patient. The physician should consult, refer, or coop-erate with other physicians, healthcare professionals, and institutions to the extent necessary to serve the best inter-est of the patient.

Societal Responsibilities

The obstetrician–gynecologist has a continuing responsibility to society as a whole and should support and participate in activi-ties that enhance the community. As a member of society, theobstetrician–gynecologist should respect the laws of that society. As professionals and members of medical soci-eties, physicians are required to uphold the dignity and honor of the profession.

Informed Consent

The primary purpose of the consent process is to protect patient autonomy. By encouraging an ongoing and open communication of relevant information (adequate disclo-sure), the physician enables the patient to exercise personal choice. This sort of communication is central to a satisfac-tory physician–patient relationship. Discussions for the purpose of educating and informing patients about their healthcare options are never completely free of the infor-mant’s bias. Practitioners should seek to uncover their own biases and endeavor to maintain objectivity in the face of those biases while disclosing to the patient any personal bi-ases that could influence the practitioner’s recommenda-tions. A patient’s right to make her own decisions about medicalissues extends to the right to refuse recommended medical treat-ment. The freedom to accept or refuse recommended med-ical treatment has legal as well as ethical foundations.

In order to give informed consent, a patient must be able to understand the nature of her condition and the benefits and risks of the treatment that is recommended as well as those of the alternative treatments. A patient’s capacity to understanddepends on her maturity, state of consciousness, mental acuity, education, cultural background, native language, the opportunity and willingness to ask questions, and the way in which the information is presented. Diminished ca-pacity to understand is not necessarily the same as legal in-competence. Critical to the process of informing the patient is the physician’s integrity in choosing the information that is given to the patient and respectfulness in present-ing it in a comprehensible way. The point is not merely to disclose information, but to ensure patient comprehen-sion of relevant information. Voluntariness—the patient’s freedom to choose among alternatives—is also an impor-tant element of informed consent, which should be free from coercion, pressure, or undue influence.