Legal issues in obstetrics and gynaecology

Abstract

Although obstetrics and gynaecology is one of the oldest medical fields that have existed, yet it was not until the second half of the twentieth century that we saw a great technological development in this area. This development brought about with it a great change in the role of women and in the consumer-oriented climate of health care, as well as a new approach to obstetric management including new options not only for the women themselves but also for those who are concerned with their obstetric care. As a result of this turmoil, numerous ethical and legal dilemmas have arisen in the field of obstetrics and gynaecology. In obstetrics, the duty of beneficence, which can be defined as the doctor's duty to act in the best interests of the patient, has gained new significance. The reason is that the obstetrician has the problem of caring for two patients rather than for one, namely, the pregnant woman and her unborn child. Today, women have a voice with respect to the treatment given to them, especially because recently there has been a great emphasis on "woman-centred" care. This has greatly effected the autonomy of medical staff, with professional monitoring and new demands for protection of patients' rights. However, in obstetrics, the woman's wishes may not always be adhered to such as those situations where a pregnant woman refuses life-saving treatment. This leads to the controversial topic re the rights of the unborn child. The obstetrician often finds himself in a dilemma when to do what the mother desires might harm her baby, or to do what is in the best interests of the foetus might harm the mother. The question arises as to how far, if at all, should the rights of the unborn child override those of the mother. Throughout this thesis, I have addressed these and many more dilemmas that arise in obstetrics and gynaecology. However, one must bear in mind that there may be no one correct answer to these dilemmas since this often depends on personal moral views which vary from one person to another. Thus, I have exposed the dilemmas as they exist together with the relative competing values, whilst taking into consideration the availability of services and resources.