The Anaesthetist, Obstetrics, and Ethics

The Anaesthetist, Obstetrics, and Ethics

  • Issue 64

Antoine Baumann | Department of Anaesthesiology and Intensive Care, Centre Hospitalier Universitaire de Nancy (CHU Nancy), Nancy, France

Over time, modern medicine has evolved from paternalism to a person’s autonomy and values-centred care. Obstetrics did not escape this progress. This evolution is indisputably a major advance regarding the respect of individual dignity, but it entails a number of difficult issues and risks in daily medical practice – especially in obstetrics. Alongside the obstetrician, the obstetrical anaesthetist has to face (deal with) them everyday of his/her professional life.

The future mother and the unborn baby are together a unique biological, physiological, pharmacological, legal… and ethical entity. The ancient question ‘Shall we save the mother or the child?’ is long outdated! We shall provide the best possible care to both and best honour the right of these two entwined human beings to have their life and health best protected. In this regard, classical ethical approaches are often challenged (questioned) and even sometimes defeated.

Over the last few decades obstetrics experienced a great deal of scientific, technical, organisational, and ethical and legal evolutions and even revolutions. Every new knowledge, new technique, new organisation, or philosophy of medical care generates new situations, new spaces of freedom, and also new types of uncertainties and difficulties. Therefore new types of judgements and decisions to be made arise. Moreover, each person, each situation is different and requires an individual and personalized solution. Conversely, each decision made for an individual impacts all the community. At this point the ethical questioning begins: ‘In this particular situation, what choice, what decision should we make to do the best or at least avoid harm?’

In obstetrics more than in any other medical specialty the choices of a person – who is not a patient but a future mother – can defy the values of medicine and/or the values of society. In obstetrical anaesthesia more than in any other subspecialty of anaesthesiology the choices of his/her colleagues ethically involve the anaesthesiologist.

In the various obstetrical ethical issues the classical Beauchamp and Childress four principles of medical ethics – autonomy, beneficence, non-maleficence, and justice – are more than ever challenged, concerning both the hierarchization of the principles and the content of each principle. The obstetrical ethics reflections have indeed to embrace and consider at the same time the interests and the rights of the future mother as well as those of the unborn baby, the values of the future mother as well as those of society, and also universal values. As in all ethical reflections it entails a part of ethics of conviction and a part of ethics of responsibility to try to safeguard both the individual and the community for the present and for the future.

Sometimes we succeed. Sometimes we face unassailable and insoluble difficulties because the different interests and values conflict definitely and irremediably, and the final decision could sometimes defy the classical universal, medical, or societal values.

During this London 2016 Euroanaesthesia Congress three colleagues will provide their different experiences on three very interesting and important obstetrical topics and with the most meaningful and up to date elements of reflection:

Dr. Felicity Plaat from London, UK, will speak about ‘My baby and my choice: patient decision making at the time of caesarean section’.

Dr. Alexandra Schyns-van den Berg from Dordrecht, The Netherlands, will give a talk on ‘Ethical choices in home delivery’.

And Dr. Bela Fulesdi from Debrecen, Hungary, will report his experience with ‘Catastrophic head injury and continuing pregnancy’.

The ESA Newsletter readers are kindly invited to attend this special session this May in London.