Ethical Dilemmas in Obstetrics & Gynecology

Modern medical technology has made remarkable scientific advances in obstetrics and gynecology, but these very same advances present unprecedented ethical challenges. In contrast to thousands of years of human history, scientific advances have placed much of conception, pregnancy and childbirth under medical control. While many of these advances hold out the promise of greater happiness--the potential of parenthood for some, the successful treatment of some fetal conditions in utero--they also pose significant ethical dilemmas.

History

• Medical advances in the 19th century took birth out of the home and into the hospital.

  Like all questions in medical ethics, questions in obstetrics and gynecology are shaped by religious and cultural concerns. In the 4th century B.C., physicians in classical Greece who took the Hippocratic Oath--one of the earliest codes of medical ethics--specifically promised they would not assist a woman who sought to abort her child. Some cultures have strong objections to male physicians present during delivery, and for centuries obstetrics and gynecology were largely the preserve of female midwives. Major advances in birthing technology in the 19th and 20th centuries, such as the development of chloroform-based anesthesia, revolutionized the field and increasingly took birth out of the home and into the hospital.

Economics

• While religion and culture play major roles in the ethical considerations of obstetrics and gynecology, perhaps an even more important element is economic: the decision of how to allocate scarce resources to meet the needs of pregnant patients. In the affluent West, for example, women are increasingly choosing elective C-sections: although normal deliveries are expected for 90 to 95 percent of births, 31.5 percent of American women had C-sections in 2007--in part because of physicians' concerns over malpractice lawsuits. C-sections also cost twice as much as regular births, a fact that gives pause to the medical insurance industry as well.

Considerations

• Abortion is an issue that focuses many of the ethical concerns in the field. Religions and secular legal systems differ on when to identify the fetus as a human being, and many societies view male children as economically preferable to females. Inexpensive and widely available sonogram technology allow many parents to choose early abortions in order to have a child of a specific gender. After the radical race policies of the Holocaust, eugenics was widely discredited, but the mapping of the human genome has made it increasingly possible for women undergoing in vitro fertilization to select embryos on the basis of their genetic makeup, a procedure known as pre-implantation genetic diagnosis. Embryos that have genetic defects--or possibly characteristics felt to be undesirable by the parents--are discarded. This practice raises significant ethical considerations and may have a long-term impact on the human gene pool

Benefits

• In vitro fertilization and its medical predecessor, artificial insemination, allow many otherwise childless couples the possibility of parenthood. This technology, which has been widely used since the first so-called "test tube baby" was born in 1979, separates conception from parenthood in a radical manner: a child may be born from a sperm donor, an ovum donor, or both.

Effects

• Modern medical technology in obstetrics and gynecology, while seemingly miraculous, has the potential to radically alter human society, and medical practitioners are faced with ethical dilemmas one pregnancy at a time. Abortions motivated solely by sex selection are widespread in Southeast Asia. In China, the resulting "gendercide" has created an imbalance that, by 2020, one in five men are expected to have difficulty finding a mate. Parenthood is now available to single adults, through the agency of donors and surrogates, and this may alter the traditional conception of the family.