PROBLEMS OF THE SPECIALITY UNITS

Introduction

Maternity nursing is an exciting and dynamic area of nursing practice. With that
excitement come issues related to ethical challenges, high rates of litigation in obstetrics, and the
challenge of practicing safe and evidence-based nursing care that is responsive to the needs of
women and families. Ethics involves determining what is good, right and fair. Ethical issues arise
everyday in healthcare and everyone has a role to play in ensuring the ethical delivery of care.
Health care givers, particularly midwives, perinatal and neonatal nurses, face ethical issues
possibly because of their interactions with patients and clients in the reproductive age groups.

PROBLEMS:-

Informed consent

Informed consent Informed consent has four key components: disclosure,

comprehension, competency, and voluntariness. It occurs prior to initiation of the procedure or
specific care and addresses the legal and ethical requirement of informing the client about the
procedure. The physician or advanced practice nurse is responsible for informing the client about
the procedure and obtaining consent by providing a detailed description of the procedure or
treatment, its potential risks and benefits, and alternative methods available. If the client is a
child, typically this information is provided to the parents or legal guardian. The nurses
responsibility related to informed consent includes:

Ensuring that the consent form is completed with signatures from the client (or parents or legal
guardians if the client is a child)

Serving as a witness to the signature process

Determining whether the client or parents or legal guardians understand what they are signing
by asking them pertinent questions Although laws vary from state to state, certain key elements
are associated with informed consent
Confidentiality

With the establishment of the Health Insurance Portability and Accountability Act
(HIPAA) of 1996, the confidentiality of health care information is now mandated by law. The
primary intent of the law is to protect health insurance coverage for workers and their families
when they change or lose jobs. Another aspect of the law requires the Department of Health and
Human Services to establish national standards for electronic transmission of health information.
The plan also addresses the security and privacy of health information. In maternal and child
health care, information is shared only with the client, legal partner, parents, legal guardians, or
individuals as established in writing by the client or the childs parents. This law promotes the
security and privacy of health care and health information for all clients. Client information
should always be kept confidential in the context of the state law, as well as the institutions
policies. Exceptions to confidentiality exist. There must be a balance between confidentiality and
required disclosure. If health care information must be disclosed by law, the client must be
informed that this will occur.

Selective reduction Induced ovulation and in vitro fertilization sometimes results in

multifetal pregnancies. If the number of exceeds the woman's ability to carry them to the point
where they can survive outside the uterus, physician may recommend selectively terminating one
or more foetuses. In these situations, the ethical dilemmas are much the same as they are for
abortion. Further complicating the issue is that these are long awaited, desired children.

Intrauterine treatment of foetal conditions Advances in intrauterine diagnosis of foetal

malformations have led to new, albeit still experimental, development in intrauterine fetal
surgery aimed at improving foetal outcomes. These new treatments raised ethical and legal
questions about maternal vs fetal rights. Who has the right to give consent? Can a court of law
overides the mother's wish if she says ''no''? Similar ethical dilemma arise during labour if a
mother refuses ceasarian section although it is clearly (in the judgement of the health care
provider) in the best interest of her foetus.

Mandated contraception The availability of contraception that does not require taking a
regular oral dose, such as using a hormone-releasing patch or having hormone injections, has led
to speculation about whether certain women should be forced to use this method of birth control.
Requiring contraception has been used as a condition of probation, allowing women accused of
child abuse to avoid jail terms.

Foetal injury

If a mothers actions cause injury to her foetus, the question of whether she should be
restrained or prosecuted has legal and ethical implications. In some instances courts have issued
jail sentences to women who have caused or who may cause injury to the foetus. This response
punishes the woman and places her in a situation in which she cannot further harm the fetus. In
other cases, women have been forced to undergo cesarean births against their will when
physicians have testified that such a procedure was necessary to prevent injury to the foetus.

Violence against women

Violence against women is multi-faceted and reflects the unequal power relationship of
men and women in virtually all societies. Enforced marriage or marriage at a very young age,
lack of information or choice about fertility control, lack of education or employment
opportunities, and lack of choice about pregnancy within marriage are forms of coercion that
result from unequal power relationships and set up environments that aggravate the risk of
violence against women.

Violence against women is condemned, whether it occurs in a societal setting (such as

female genital mutilation) or a domestic setting (such as spousal abuse). It is not a private or
family matter.

Violence against women is not acceptable whatever the setting, and therefore physicians
treating women are ethically obligated to:

(i) Inform themselves about the manifestations of physical, social and psychological
violence, and learn to recognise cases. Documentation must take into account the need for
confidentiality to avoid potential harmful consequences for the woman, which may require
separate, non-identifiable compilation of data.
 (ii) Treat the physical and psychological results of the violence.

(iii) Affirm to their patients that violent acts towards them are not acceptable.

(iv) Advocate for social infrastructures to provide women the choice of seeking secure
refuge and ongoing counselling.

Sex selection for non-medical purposes

Preamble

The international context of sex selection is grounded in a setting where the majority of
women are disadvantaged in enjoyment of economic, social, educational, health, and other
rights. The global impact of the desire to achieve sex selection has resulted in systematic rights
abuses such as selective abortion of female fetuses, female infanticide, neglect of girl children
and failure to provide either access to or support for health care of girls. This has led to a global
imbalance of variable intensity in the sex composition of populations.

The Committees deplore all forms of discrimination against women and the use of any
medical techniques in any way that would exacerbate discrimination against either sex.

Sex selection is of particular ethical concern when it is driven by value differences

ascribed to each sex or that arise from pervasive gender stereotypes.

In viewing medical and scientific association guidelines throughout the world, common
ethical issues raised include concerns about the selection for children with presumed gender
characteristics desired by their parents rather than being an end in and of themselves.

Legal approaches to sex selection for non-medical reasons vary by country and range
from no specific regulation of this issue to complete prohibition and criminalization.

Present Technology

It is possible to select the sex of an embryo or fetus for non-medical reasons by the same
techniques that are usually performed for prevention of sex linked disabilities.
 The techniques for sex selection have expanded throughout pre conception and post
conception. Preconception sex selection includes sperm separation. Pre implantation genetic
diagnosis (PGD) necessitates in vitro fertilization and embryonic cell biopsy. After implantation
is established, Y fetal DNA can be identified in maternal blood by polymerase chain reaction
(PCR). Chorionic villous sampling (CVS), amniocentesis or echography are additional means
that can identify fetal sex.

Guidelines

1. The use of sex selection to avoid sex linked genetic disabilities is generally considered
justifiable on medical grounds.
2. Because sperm separation and PGD avoid termination of an ongoing pregnancy, they
may appear to be less objectionable techniques for non-medical sex selection. However,
since they can also result in gender discrimination, in this respect they are not ethically
different from those means used in ongoing pregnancy.
3. Professional societies must ensure that their members and their members staff are
accountable for the employment of techniques for sex selection only for medical
indications or purposes that do not contribute to social discrimination on the basis of sex
or gender.
4. Where a regional area has a marked sex ratio imbalance, the professional societies should
work with their governments to ensure that sex selection is strictly regulated to contribute
to the elimination of sex and gender discrimination.
5. Procreative liberty warrants protection, except when its exercise results in sex
discrimination. The individual right to procreative liberty needs to be balanced by the
communal need to protect the dignity and equality of women and children.
6. Irrespective of the approach to non-medical sex selection, all health professionals and
their societies are under an obligation to advocate and promote strategies that will
encourage and facilitate the achievement of gender and sex equality.