Legal and

Ethical
Issues in
Obstetrics
Presented By,
Barasha Kalita
 Definition
-- systemic approach to understand,

Ethics
analyse, and distinguish matters of
risk and wrong good and bad
admirable and deplorable as they
related to the well being of the
relationship among sentient being .
Legal issues – legal issues are decided by
law

Law – defined as “ a rule of conduct or

action which are put in place to ensure
public safety and control undesirable
behaviour .
Ethical framework
and perspective
Virtue ethics – virtue depends on
quality to character to health
professionals

Care based ethics- The moral action

centres on interpersonal
relationship ,one value is
Placement of caring and
relationships over Logic and
reason.
 Feminist ethics -
recognizes that
gender is just one
aspect of a person's
identity and
experience
Communitarian ethics -
Rights
Ethical assessment framework
Assessment
1. Identify the problem 6. Identify and use
2. Gather relevant facts relevant
3. Identify method of ethical interdisciplinary
justification to resolve resolve ethics
the dilemma committee ,ethic
4. Consciously clarify consultant , literature
relevant values, right ,
duties of patient 7. Identify if there is
5. Identify guidelines from an ethical dilemmas
nursing and professional present
codes of ethics
8. Identify and
prioritise alternative
action
 Patient
Rights
• Right to be treated with Respect and dignity
• The right to freedom
• Right to use informed choice in healthcare
• Right to accept or refuse treatment
• Right to full disclosure of financial factor
• Right not to abandoned and neglected
• Right to absolute privacy
 General legal concept

• Floating
• Accountabilit • Negligence
y • Charting
• Standard of • Informed
care consent
• Statutory • Maternal
law rights
• Common • Insurance
ETHICAL PRINCIPLES
Respect for person –It directs individual to treat
themselves and others with respect inherent to
man’s humanness

Respect for autonomy – It is right of the individual

governing their actions according to their own
purpose and reason. So health personnel obtain a
patient informed consent for treatment.

Respect for freedom – nurses as a group believe that

patient should have greater freedom of choice within
nations health care system
Respect for beneficence – beneficence principle state
that the action one takes should promote good

Respect for non malfeasance –it states that one

should do no harm

Respect for veracity – veracity concern with telling

truth and incorporate the concept that individual
should always tell the truth.

Respect for justice– justice concern the issue that

person should be treated equally and fairly
Respect for right – right is an entitlement to behave
in certain way under circumstances ,such as nurse
entitlement to freely express personal beliefs and
perform voting in a political election.

Confidentiality– Is the keeping ones promises or

commitment ,it provides that a nurse should respect
person privacy.
Ethical legal issues in
obstetrics
Maternal issues
 Surrogacy
A surrogate mother is someone who
gestate and gives birth to a child for
another person with full intention of
handing over to person after birth.

Surrogacy considered
when –
 Ethical issues:

1. What are pros and cons of using unused embryos for medical
research?

2. Is there anything wrong with disposal of unused embryo leaving

them on counter to unthaw and degenerate?

3. What If surrogate Decide to maintain her privacy ?

4. What if surrogate and spouse violates the abstention clause ?

5. What if surrogate decide to keep the baby ?

Ethical issues:

● Is there anything wrong with surrogate giving her unused embryo

to someone else

● Who would make a decision to unthaw frozen embryo

● Is handling over a child after delivery for a

● Do women participate in surrogacy to save their marriage

● Is it wrong for a surrogate to abort

● What if surrogate with genetic ties demand to visit her child

Egg donation
Egg donation may be used successfully in treatment of multiple causes of
infertility ,as well as some genetic disease.
Egg donation usually used in following situations—

• Egg donors may be anonymous or

unknown to patients requiring this
procedure , anonymous egg donor are
typically women younger than 30 years .

• They will undergo series of of cycle of

hormonal ovarian stimulation and egg
retrieval for purpose of helping infertile
couples.
Artificial reproduction technique
Artificial insemination

Numerous legal problems from the

practice of artificial insemination
●Insemination of wife with her husband
sperm
●Artificial insemination of women with a
donors sperm
The primary indication for artificial insemination of
donors are

● Male Infertility
● Genetic problem

1. Is child conceived illegitimate ?

2. Does AID constitute criminal adultery or adultery that called
lead to divorce on those ground
3. Would the donor be held liable for rape if women devices she
gave consent
●In-vitro fertilization

One of the most recent ethical

dilemmas brought to the focus by
modern obstetrics is the issue of in
vitro fertilization.

If child born with this method is

physical and mental handicapped, the
issue of IVF is certainly legally morally
and ethically significant as use of this
technique proliferate question will
1. With IVF the ovum is fertilized outside
the body and then implanted into the
uterus.

2. Between 15 to 20 embryo’s may result

from a single fertilization effort

3. Only 3to 5 this are implanted in the

women’s uterus

4. Ethical question may arise what to do

with the remaining embryos

5. Although the procedure has allowed

infertile couple to have children some
Abortion
Ethical considerations: from an ethical
perspective abortion is essentially the
removal of women’s support from the
foetus leading to foetal death.
Social issues:
● Sex selective abortion and female
infanticide sonography and
amniocentesis allows parent
through determine sex before birth
● It is suggested that sex selective
abortion might be partially responsible
for the noticeable disparity between
the birth rates of male and female
children is reported in many areas of
Asia

● In India economic roles of man the

cause associated with dowry's a Hindu
tradition who is dictate death funeral
rites must be performed by main
relatives have led to preference for
son .
 ● Ethical issues:
1. During the first trimester the state cannot bar anywhere
women from obtaining an abortion from licenced physician

2. In the second trimester the state can regulate the

performance if an abortion if such regulation relates to
protection of women health

3. In third trimester the state can regulate and event prohibit

abortion except those seem necessary to protect the
women’s life and health and state may impose safeguard
for the foetus

4. Ethic and medical aspect of obstative anaesthesia and

inform consent.
Prenatal screening –
1. Can detect the inherited and congenital abnormalmalitis long
before birth.
2. Early diagnosis may allowed repair of anomaly in the utero
3. Help patient fully understand the procedure
● Amniocentesis
● Other prenatal diagnosis
Sexual counselling:
Should be done by train sexual
counsellor who skilled in helping
people with sexual problem
Sterilization
● Most sterilization operation are elective
● Inform consent
Genetic counselling
Before genetic counselling accurate diagnosis might
be done.
The purpose of counselling is to enable the couple to
understand that recurrent risk, couple who receive
genetic counselling maybe unwilling to inform these
to relatives because of guilt and embarrassment even
though they have an obligation to notify these person.
● patient who received genetic counselling have right
to privacy
 Home Births

Many health professional

are reluctant to attend
home birth because they
fear a malpractice action
of problem arises
● Ethical issues related
to pre implantation genetic
Diagnosis
Foetal and legal issues in prenatal and labor
care:
1. Fetal monitor
2. During labor and delivery
3. Maternal complications
4. Still born infant
5. Neonatal complications
6. Ethical issues in neonatal care and
Foetal issues
Foetal research
Foetal research is a criminal offences
and states that foetal research have
place many constraints on this
activity
●Foetal therapy
●Foetal right –
1. Foetal tissue research –
Transplanted foetal nerve cell helps
to generate new cells in patient that
 ●Some are concerned with whether
no of abortion will increase in
response in need for the tissue and
whether this is an ethical use of
human tissue.
2.Eugenics and genetic manipulation –
Gene therapy can prevent and man
age different disorder
Research can learn the sex of fetus
and whether it suffers from certain
4.Cord blood banking–
Cord blood taken from the
new-born umbilical cord at
the time of birth may play a
role in combating leukaemia
, certain other cancer and
immune system and blood
system disorder.
●Collecting involves no
risk to mother and
 Ethical issues

1. Who owns the blood ?the donor ? the

parents? Private blood bank society
2. How will inform be obtain and by whom?
3. How will confidentiality be ensured
● How will obligation to notify family and
donor be address if testing of blood
reveal infectious disease
● How will the harvest blood be allocated
to ensure fairness and availability to
individual from all races.
Embryonic stem cell research
●Human stem-cells can be
found in embryonic tissue and
in the primordial germ cell of a
foetus . Research has
demonstrated that in tissue
culture this cell can be made
to differentiate in the other
types of such as blood
cell ,nerve cell which might be
used to treat problem such as
● Ethical issues are

● What neonatal status should be attached to human

embryo? How should an embryo be viewed?

● What resources of embryonic tissue are acceptable

for research? it is ever ethical to create embryo
solely for stem cell research ?is there justification
for using embryo remaining after fertility treatment?
Human genome projects

Is international multi disciplinary

efforts to explore and map all
human genetics material ,
mapping the human genome is
the first step in process of
attempting to understanding
nature of hereditary disease and
finding the ways identify the
 Other issues
Colustrum feeding
 Shortly after birth and
preferably before the first
feeding small piece of
softened date is rubbed on
the new-born palate , the
parent or respected family
member usually perform this
ritual because it is performed
along with supplication family
may ask a respected personal
Role of nurse
 Fun quiz

1.Which one of these is not an

ethical principle ?

A. Beneficence C. Virtue
ethics
B . Autonomy D.
2. This film has shown one of the ethical
issues --- guess the issue
A.Maternal issue C.fetal
research
B.Surrogacy D.female
foeticide
3.Mention 3 roles of nurse in legal and
ethical issues in obg

4.Eugenics and gene manipulation is

under which ethical issues
A. Maternal. B. Foetal C. Other

5.Mention 5 maternal issues ?

Conclusion