INTRODUCTION • Ethical issues across the child

bearing ages are multiple and

complex. Nursing is a process that
involves judgement and action
with the aim of maintaining,
promoting and restoring balance
in human system. The need for
judgement and action brought
about the moral questions of right
or wrong of duty. The end purpose
of nursing is the welfare of other
human beings.
ETHICAL PRINCIPLES AND FRAMEWORKS
• Ethical principles are a set of rules that can be applied to
all situations. They provide a framework for helping nurses
and others evaluate ethical issues.
• Ethical and social issues affecting the health of pregnant
women and their fetus are increasingly complex. Some of
the complexity arises from technological advances in
reproductive technology, maternity care, and neonatal
care. Nurses are autonomous professionals who are
required to provide ethically competent care.
 Some ethical principles related to
patient care include:
• Autonomy: The right to self determination
• Respect for others: Principle that all persons are equally
valued
• Beneficence: Obligation to do good
• Nonmaleficence: Obligation to do no harm
• Justice: Principle of equal treatment of others or
that others be treated fairly
• Fidelity: Faithfulness or obligation to keep promises
• Veracity: Obligation to tell the truth
• Utility: The greatest good for the individual or an
action that is valued
Ethical principles that guide ethical action include
four primary moral principles: respect for
beneficence, non-maleficence, justice, and
autonomy, which upholds the rights of individuals
and families. A key way for nurses to respect
autonomy is through support of childbearing
women, including adolescent women.
Ethical Issues and Challenges in
Maternal and Child Health Nursing

• Maternal and child health issues often involve

conflicts in which a woman behaves in a way
that may cause harm to her fetus or is
disapproved of by some or most members of
society. Conflicts between a mother and fetus
occur when the mother’s needs, behavior, or
wishes may injure the fetus.
The most obvious instances involve:
• Abortion
• Assisted reproduction (artificial insemination, invitro
fertilization and embryo transfer, and surrogate
parenthood)
• Selective reduction in multifetal pregnancy
• Intrauterine treatment of fetal conditions
• Substance abuse
• Refusal to follow the advice of caregivers
ABORTION
• It has become a hotly debated political issue that
separates people into two camps: prochoice and pro-
life.
The pro-choice group supports the right of any woman
to make decisions about her reproductive functions
based on her own moral and ethical beliefs.
The prolife group feels strongly that abortion is murder
and deprives the fetus of the basic right to life.
• Abortion is a complex issue, and the controversy is not
only in the public arena: many nurses struggle with the
conflict between their personal convictions and their
professional duty.
• Nurses need to clarify their personal values and beliefs on
this issue and must be able to provide non biased care
before assuming responsibility for clients who might be in
a position to consider abortion. Their decision to care for or
refuse to care for such clients affects staff unity, influences
staffing decisions, and challenges the ethical concept of
duty.
• The ANA’s Code of Ethics for Nurses upholds the nurse’s
right to refuse to care for a client undergoing an
abortion if the nurse ethically opposes the procedure.
• Nurses need to make their values and beliefs known to
their managers before the situation occurs so that
alternative staffing arrangements can be made.
• Open communication and acceptance of the personal
beliefs of others can promote a comfortable working
environment. Nurses need to understand abortion laws
and the conflicting beliefs that divide society on this
issue.
S U B S TA N C E A B U S E
Substance abuse for any person is a problem, but when it
involves a pregnant woman, substance abuse can cause fetal
injury and thus has legal and ethical implications.
In some instances, courts have issued jail sentences to
pregnant women who caused harm to their fetuses. Many state
laws require reporting evidence of prenatal drug exposure,
which may lead to charges of negligence and child
endangerment against the pregnant woman.
This punitive approach to fetal injury raises ethical and
legal questions about the degree of governmental control that is
appropriate in the interests of child safety.
F E TA L T H E R A P Y
• Fetal therapy is becoming more common as techniques
improve and knowledge grows.
• Although the risks to the fetus and the mother are both
great, fetal therapy may be used to correct anatomic
lesions.
• Some argue that medical technology should not interfere
with nature, and thus this intervention should not take
place. Others would argue that the surgical intervention
improves the child’s quality of life.
 Nurses play an important supportive role in
caring and advocating for clients and their families.

As the use of technology grows, situations will

surface more frequently that test a nurse’s belief
system.
Encouraging open discussions to address
emotional issues and differences of opinion among
staff members is healthy and increases tolerance for
differing points of view.
INFORMED CONSENT
Informed consent has four key components:
• Disclosure
• Comprehension
• Competency
• 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.
REFUSAL OF MEDICAL TREATMENT
Refusal of treatment may occur when the treatment
conflicts with religious or cultural beliefs. In these cases, it is
important to educate the client and family about the
importance of the recommended treatment without
coercing or forcing the client to agree.

• Sometimes common ground may be reached between

the family’s religious or cultural beliefs and the health care
team’s recommendations.
• Communication and education are the keys in this
situation.
• If providing medical treatment may save a child’s life,
health care providers and the judicial system strive to
advocate for the child.
• The state has an overriding interest in the health and
welfare of the child and can order that medical
treatment proceed without a signed informed consent.
This is referred to as parens patriae (the state has a right
and a duty to protect children).
 Parents may refuse treatment if they perceive
that their child’s quality of life will be significantly
impaired by the medical care that is offered. If the
parents refuse treatment but the health care team
feels the treatment is reasonable and warranted, the
case should be referred to the institution’s ethics
committee. If the issue remains unresolved, then the
judicial system becomes involved.
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.
• 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
child’s 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 institution’s policies.
SELECTIVE REDUCTION
Induced ovulation and invitro fertilization sometimes
result 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 fetuses.

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 FETAL CONDITIONS
Advances in intrauterine diagnosis of fetal
malformations have led to new, although still experimental,
development in intrauterine fetal surgery aimed at improving
fetal 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 override the mother's wish if she says
''no‘’?
Similar ethical dilemma arises during labor if a mother
refuses caesarian section although it is clearly (in the
judgement of the health care provider) in the best interest of
her fetus.
M A N D AT E D C O N T R A C E P T I O N
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.
Some people believe that mandated contraception is
a reasonable way to prevent additional births to women
who are considered unsuitable parents and decrease
government expenses for dependent children.
• Requiring poor women to use contraception to limit the
money spent supporting them is legally and ethically
questionable and does not address the obligations of
the children’s father.
• Such practice interferes with a woman’s constitutional
rights to privacy, reproduction, refusal of medical
treatment, and freedom from cruel and unusual
punishment. In addition, medication may pose health
risks to the woman.
• Access to free or low-cost information on family
planning would be more appropriate and ethical.
F E TA L I N J U R Y
• If a mother’s actions cause injury to her fetus, 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
fetus. 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 procedure was necessary to prevent
injury to the fetus.
I N F E R T I L I T Y T R E AT M E N T
Perinatal technology has found ways for some previously
infertile couples to bear children. Many techniques are more
successful, but ethical concerns include the high cost and
overall low success of some infertility treatments.
Other ethical concerns focus on the fate of unused
embryos.
• Should they be frozen for later use by the woman or someone
else or used in genetic research?
• What if the parents divorce or die?
• Who should make these decisions?
In multiple pregnancies with more fetuses than can be
expected to survive intact, reduction surgery may be used to
destroy one or more fetuses for the benefit of those remaining.
Reference:
• doi: http://dx.doi.org/10.14194/ijmbr.5.2.3
• Aderemi R.A. Ethical Issues in Maternal and Child Health
Nursing: Challenges Faced By Maternal and Child Health
Nurses and Strategies for Decision Making. Int J Med
Biomed Res 2016;5(2):67-76