Ethical Standards
The Fetal Care Center of Cincinnati commits to the highest ethical standards in patient care, therapeutic innovation, and research. This document guides the health care professionals under the auspices of the Fetal Care Center.
Policy
The practice of medicine is a moral enterprise involving values that may conflict. Autonomy, beneficence/nonmaleficence, justice, veracity and fidelity are well defined and supported ethical values in medicine. It is important to consider these values both from the patient’s/family’s perspective and the health care professional’s perspective. The ongoing relationship between the health care professional and the patient/family trust and respect form the foundation on which decisions are made. The above values may provide clarity and guidance when there is a difference of opinion. For the purposes of this document we define these terms as follows:
Definitions
- Autonomy refers to a person’s right to make choices regarding oneself. A pregnant woman is in a unique position in that she is/represents, in effect, two patients, herself and her fetus (or her children in the case of a multiple pregnancy). An autonomous informed decision made by a pregnant woman will affect both patients. Autonomy also refers to the self-governance of the health care professional, in so far, as the health care professional comes to the relationship with a set of moral standards by which to live.
- Beneficence and nonmaleficence entail acting to benefit a person and to avoid harm. These principles require trust in the patient/health care provider relationship such that appropriate recommendations will be made to honor these values. Treatments that result in short-term harm may be recommended and tolerated for long-term benefit.
- Justice, though defined multiple ways, is most frequently understood in the health care context as allocation of health care according to need, regardless of the ability to pay. It is not allocation according to contribution, effort or entitlement.
- Veracity or truth telling is the hallmark of a fiduciary relationship. In order to provide quality health care, the health care professional requires accurate information pertinent to the problem from the patient or family. In addition, the patient or family needs accurate information about the diagnosis, prognosis, and treatment options in order to make an informed decision.
- Fidelity is the obligation to act in good faith to keep vows and promises, to honor ethical principles, to fulfill agreements, to maintain relationships and fiduciary responsibilities.
In addition to the ethical values discussed above, the ethical integrity of the health care professional is vital to the delivery of quality health care. It involves a moral attitude and sensitivity to other people’s needs whether patients, families, colleagues and includes such virtues as compassion, empathy, honesty, humility, and courage. Courage, in this context, implies that a health care professional maintains his/her moral stance.
Implementation
Patient Care
- All patients referred to the Fetal Care Center will be offered a comprehensive fetal evaluation regardless of their socioeconomic status. (Justice)
- The services of social services, pastoral care, and bioethics will be available to all patients evaluated at the Fetal Care Center. (Autonomy; Justice)
- In cases in which it is known that the fetus is not viable, the birth plan is a basis for communication among team members regarding the patient and family decision to forego life-sustaining treatment and for comfort care. (Autonomy; Beneficence/Nonmaleficence)
- When a therapeutic intervention is being considered, the physician will obtain informed consent from the patient. (Autonomy; Veracity)
- a. The physician will impart the information necessary for an informed decision, including assessment of competence, disclosure, understanding, voluntary participation in treatment and giving consent.
- b. If the mother and father disagree, assistance in resolving the disagreement should be sought from social work, pastoral care, or bioethics, and family advocacy officer.
- c. By law, the decision rests with the mother who is capable of arriving at an informed decision.
- d. A minor mother may present for evaluation, but no intervention will be undertaken without the written permission of the parent/guardian and minor mother
- e. In cases involving a surrogate mother, informed consent will be obtained from the surrogate. If a collaborative relationship exists between the surrogate and the person(s) contracting with the surrogate, the physician will, with the permission of the surrogate mother, obtain informed consent from the surrogate in the presence of the contracting parties. The physician will seek agreement from both parties, but ultimately the decision lies with the surrogate mother. In the event of conflict, social service, pastoral care, bioethics, or family advocacy officer will be sought to provide assistance and guidance for conflict resolution.
- Patients and families will be provided with information regarding all options available to them including those not provided by the Fetal Care Center staff, Pediatric Surgeon, and Maternal Fetal Medicine Physicians. (Autonomy; Veracity)
- Options for treatment are presented based on the best medical information available. When decisions involve more than one therapeutic option, the physician will present therapeutic options to the patient and family explaining how the options and their risks and benefits relate to the goals of the patient and family. When a potential therapeutic option does stand out from other options, as aligned with the goals of the patient and family, then the professional has a moral obligation to explain this to the patient and family. (Autonomy; Veracity; Ethical Integrity of the Professional)
- In the situation of a monochorionic twin gestation, with danger of imminent fetal demise, where one twin is determined to have a pathology incompatible with life and is determined to be the source of risk to the viable second twin, threatening the second twin's viability and neurologic integrity, a cord ablation may be performed. Informed consent will be obtained as outlined in this policy. (Beneficence/nonmaleficence)
- The Fetal Care Center will not perform terminations of pregnancy or selective reductions in multi-fetal pregnancies. Information about medical options will be provided to the patient and the patient referred back to the referring physician for further care and treatment. (Autonomy; Veracity; Ethical Integrity of the Professional; Beneficence/nonmaleficence)
- In the instance of a health care professional asking to be removed from the care of a patient due to conflicts arising from personal moral beliefs, this request should be honored as long as doing so does not jeopardize the wellbeing of the patient. (Ethical Integrity of the Professional; Professional’s Autonomy; Beneficence/nonmaleficence, Fidelity)
Therapeutic Innovations
The Fetal Care Center is committed to quality medical care that is safe and based on the best medical knowledge available. When a therapeutic innovative procedure is offered to a patient there should be a compelling rationale and a high likelihood of success even when a clear prediction of outcome cannot be made. (Beneficence/nonmaleficence)
Research
The Fetal Care Center is committed to quality clinical research. When patients and families are referred to the Fetal Care Center they should be apprised of the research nature and identity of the program. All clinical research is governed by the ethical principles set forth in this document.
- The efficacy of innovative therapies will be determined through appropriate clinical research trials. (Beneficence/nonmaleficence)
- Informed consent will be obtained from all patients (or their legal surrogate decision-makers) enrolled in a research protocol through the Fetal Care Center. (Autonomy)
- The Fetal Care Center health care professionals integrate ethical considerations and analysis in the process of case review.
Oversight
The Fetal Care Center Clinical Director, Fetal Care Center Medical Director annual review.
Last revised August 11, 2010
