Since the founding of the University of Limburg (1974), in The Netherlands, an innovative medical curriculum has been guided by educational principles of problem-orientation, continuous assessment, student initiative and attitude development. The teaching of medical ethics was built into the preclinical curriculum from the start. However, the clinical years remained largely unaffected, and only recently has an effort been made to extend the educational philosophy to this more or less traditional part of medical education. Within this context, an experiment of (...) clinical ethics teaching was introduced in the Obstetrics and Gynaecology (Ob/Gyn) clerkships. The objectives, methods and results of this experimental programme are described in this paper. The success of the teaching is based on three features of the programme: 1) its student-centred approach; 2) the programme is designed in a way similar to regular patient conferences; 3) the programme is taught by a team consisting of both clinician and ethicist. Before starting a longitudinal programme of ethics teaching during the clinical years, it proved very helpful to experiment with a well designed and evaluated pilot programme. (shrink)

Evidence suggests a limited contribution to the total research output in leading obstetrics and gynaecology journals by researchers from the developing world. Editorial bias, quality of scientific research produced and language barriers have been attributed as possible causes for this phenomenon. The aim of this study was to understand the prevalence of editorial board members based out of low and lower-middle income countries in leading journals in the field of obstetrics and gynaecology. The top 21 journals in the field of (...) obstetrics and gynaecology were selected based on their impact factor, SCImago ranking and literature search. The composition of the editorial boards of these journals was studied based on World Bank Income Criteria to understand the representation status of researchers from low and lower-middle income countries. A total of 1315 board members make up the editorial composition of leading obstetrics and gynaecology journals. The majority of these editors belong to high-income countries (n = 1148; 87.3%). Low (n = 6; 0.45%) and lower-middle income (n = 55; 4.18%) countries make up for a very minuscule proportion of editorial board members. Only a meagre 9 out of 21 journals have editorial board members from these countries (42.85%). Low and low-middle countries have poor representation in the editorial boards of leading obstetrics and gynaecology journals. Poor representation in research from these countries has grave consequences for a large proportion of the global population and multidisciplinary collaborative efforts must be taken to rapidly change this statistic with immediate effect. (shrink)

This article reports on moral problems that were raised by medical students as the basis for an ethical case-conference in an obstetrics and gynaecology clerkship. After introducing the issue of teaching clinical ethics, the method of our case-conference is explained. Next, the variety of topics and related moral problems are presented. The article continues with a discussion of three distinct and challenging aspects that characterise obstetrics and gynaecology as a domain for teaching clinical ethics. The conclusion puts forward three significant (...) points our review raises. (shrink)

Introduction The provision of abortion services in the Republic of Ireland is legally restricted. Recent legislation that has been implemented allows for abortion if there is a real and substantial risk to the woman's life, but in general Irish women must travel abroad for abortion services. The aims of this study were to investigate the clinical experiences of Irish obstetric non-consultant hospital doctors that work in this environment and to assess their attitudes towards termination of pregnancy. Methods We conducted an (...) online cross-sectional descriptive survey of 184 Irish obstetric NCHDs. Quantitate and qualitative analysis was performed. Results There was a 28% response rate. 88% of respondents thought that ToP should be permitted for fatal fetal abnormality if the parents choose, 96% if the woman's health is severely affected and 86% in cases of rape and incest. Over 90% of respondents believed a woman's health suffers because of the need to travel abroad to undergo a ToP. Physical, psychological and social reasons were explored. The research also highlights that obstetric trainees are actively involved in the provision of preabortion and postabortion care. Conclusions The clinical experiences and opinions of the respondents suggest that the current legal availability of abortion in Ireland is insufficient to guide best clinical practice and does not represent the views of those that provide obstetric care. (shrink)

Il y a trente ans, évoquant la gynécologie dans l’Antiquité, Giulia Sissa écrivait que l’utérus, « dépositaire insensé et irritable de la reproduction sociale, est le seul organe qui a forcé la connaissance médicale hippocratique à définir en son sein une véritable spécialité ». L’ouvrage de Monica H. Green reprend, en les contextualisant dans un paradigme méthodologique beaucoup plus complexe, ses études précédentes sur la figure historique et littéraire de Trotula et sur la médecine féminin...

Book reviewed in this article: Ethics in Obstetrics and Gynecology. By Laurence B. McCullough and Frank A. Chervenak.

The ArgumentThis paper describes the way in which a simple device, the pregnancy wheel, has been used by the medical profession to impose a new way of measuring and experiencing pregnancy.The change involves counting in weeks instead of counting in months and it is gradually replacing a commonsensical method that had deep physiological and cultural roots. In contrast, the medical methodology of counting forty weeks is more complicated and lacks direct connections to the events of pregnancyIn the encounter between the (...) doctor and the pregnant woman the pregnancy wheel has a variety of uses, among them determinations of the age and estimated size of the fetus.It plays an additional role, however, in the medicalization of pregnancy by providing the doctor with privileged information. It also influences modes of thinking through the way in which it deals with the question of the beginning of pregnancy, a question that has clear moral implications. (shrink)

The aim of this study was to review the typical factors related to physician’s liability in obstetrics and gynecology departments, as compared to those in internal medicine and surgery, regarding a breach of the duty to explain.

Obstetrics and gynaecology always has reputation for being a highly litigious. The field of obstetrics and gynaecology is surrounded by different circumstances that stimulate the doctors to practice defensive..

ObjectiveThere have been increased efforts to implement medical ethics curricula at the student and resident levels; however, practising physicians are often left unconsidered. Therefore, we sought to pilot an ethics and professionalism curriculum for faculty in obstetrics and gynaecology to remedy gaps in the formal, informal and hidden curriculum in medical education.MethodsAn ethics curriculum was developed for faculty within the Department of Obstetrics and Gynaecology at a tertiary care, academic hospital. During the one-time, 4-hour, mandatory in-person session, the participants voluntarily (...) completed the Oldenburg Burnout Inventory, Handoff Clinical Evaluation Exercise, University of Missouri-Kansas City School of Medicine and overall course evaluation. Patient satisfaction survey scores in both the hospital and ambulatory settings were compared before and after the curriculum.ResultsTwenty-eight faculty members attended the curriculum. Overall, respondents reported less burnout and performed at the same level or better in terms of patient handoff than the original studies validating the instruments. Faculty rated the professionalism behaviours as well as teaching of professionalism much lower at our institution than the validation study. There was no change in patient satisfaction after the curriculum. However, overall, the course was well received as meeting its objectives, being beneficial and providing new tools to assess professionalism.ConclusionThis pilot study suggests that an ethics curriculum can be developed for practising physicians that is mindful of pragmatic concerns while still meeting its objectives. Further study is needed regarding long term and objective improvements in ethics knowledge, impact on the education of trainees and improvement in the care of patients as a result of a formal curriculum for faculty. (shrink)

The American Journal of Bioethics, Volume 11, Issue 6, Page 1-2, June 2011.

BackgroundObstetrics and gynaecology always has reputation for being a highly litigious. The field of obstetrics and gynaecology is surrounded by different circumstances that stimulate the doctors to practice defensive medicine.MethodsThis study was directed to assess the extent and the possible effect of defensive medicine phenomenon on medical decision making among different grades of obstetric and gynaecologic Sudanese doctors, and to determine any experience of medical litigations with respect to sources and factors associated with it.ResultsA total of 117 doctors were approached, (...) their distribution according to job description was as follow: consultants registrars and specialists. The majority 89.7 % had the impression that litigation against doctors are increasing and 27.6 % had a direct experience of litigation. In this study less than one half of the surveyed doctors knew the concept of defensive medicine and 71.8 % reported practicing one or another form of defensive medicine. The different sources of the litigations reported by the doctors included: maternal death, perinatal death, other {misdiagnosis, intra-uterine fetal death, uterine perforation, rupture uterus}, fetal distress, injury to viscera and shoulder dystocia. In this study the experience of medical litigation was significantly observed among those who worked in area of blame culture. In logistic regression model, there was no significant difference between those who knew the concept of defence medicine and those who didn’t.ConclusionThere should be strategic plan to reduce the practice of defensive medicine and medical litigation against doctors. (shrink)

ZusammenfassungEmpirische Daten belegen, dass die moderne Geburtsmedizin Schwangerschaft und Gebären vorrangig als krankhaft wahrnimmt, was zu einem Legitimationsdefizit führt: Eine primär invasive Geburtsmedizin verletzt das Prinzip der Nichtschädigung, verursacht vermeidbare Kosten und ist nicht ohne weiteres durch das Autonomieprinzip gedeckt. Von den unmittelbar Beteiligten ist diese Pathologisierung als eine solche jedoch kaum wahrgenommen worden. Daher stellt sich die Frage, wie es zur sozialen Akzeptanz einer derart drastischen Wahrnehmungsverschiebung kommen konnte. Da Begriffe unsere Wahrnehmung strukturieren, interessiert uns vor allem die konzeptionelle (...) Dimension dieser geburtsmedizinischen Verkehrung des Normalen ins Krankhafte, die in einer Reflexion auf die zwei Quellen legitimen ärztlichen Handelns erkennbar wird. Sowohl der Krankheitsbegriff als auch das moderne Verständnis von Selbstbestimmung weisen eine interne Unschärfe auf, die pathologisierende Tendenzen begünstigt. Der moderne Krankheitsbegriff erschwert eine klare Abgrenzung zwischen krank und gesund. Und Autonomie ist ein mehrdeutiges Konzept, das in einer spezifischen Auslegung die Pathologisierung fördert. Da beide Konzepte ärztliches Handeln rechtfertigen, bleibt ihr delegitimierendes Potential in der Praxis unscheinbar. Erst reflexiv und polylogisch lässt sich dieser blinde Fleck beobachten, so dass eine Korrektur der Pathologisierung möglich wird. (shrink)

Rufus of Ephesus (fl. c.100c.e.) was a prolific medical author and practitioner in the Imperial period whose historical importance has been obscured by the loss of most of his works. One of the largest gaps in our knowledge of Rufus’ corpus is his gynaecological writings, none of which survives in full. This article assembles and comments on several fragments from Rufus’ lost gynaecological workOn the Retention of Menses(perhapsΠερὶ τῶν ἐπεχομένων ἐμμήνων). Comparison of overlapping passages from the authors Ibn al-Jazzār (tenth (...) century) and Aëtius of Amida (sixth century) reveals that more fragments of this work in Arabic and Greek have survived than previously thought. These fragments provide new evidence for the analysis of Rufus’ medical thought, and further our understanding of gynaecology in the Roman empire. (shrink)

Physiotherapy raises serious bioethical questions that are far too little discussed. Concerns include the lack of a clearly defined end point, the closeness of interaction between therapist and patient, the patient’s own share of responsibility, and the common failure to refer patients for rehabilitation.Physiotherapy has evolved dramatically in recent years, to the point where it is now a major healthcare profession offering assessment, diagnosis and treatment for a wide range of conditions, from sports injuries to rehabilitation for major injuries and (...) diseases. According to the World Confederation for Physical Therapy, “Physical Therapy is providing services to people and populations to develop maintain and restore maximum movement and functional ability throughout the lifespan” .1However, almost uniquely among the healthcare professions, physiotherapy has aroused little or no philosophical interest or engagement. This is surprising, because some of the salient features of physiotherapy raise interesting and to some extent novel problems in ethics. There are, it is true, some papers on ethically related themes,2–5 but in comparison with the size of the discipline and the complexity of the problems, the profile of physiotherapy in bioethics is worryingly low.A first problem is that unlike many areas of medicine—surgery, for example, or radiography or obstetrics and gynaecology—physiotherapy has no obvious end point. In medicine, the end points of treatment are generally well defined, with only a few exceptions, such as plastic surgery or psychiatry. It is my impression that physiotherapy, with few exceptions, does not operate with the concept of end points. Although what physiotherapy aims at is clear, the point at which the aims are achieved is uncertain. For example, in many cases the patient would go on benefiting from sessions of physiotherapy, perhaps with diminishing returns but still with …. (shrink)

Women were involved in both practical and theoretical aspects of scientific endeavour in the ancient world. Although the evidence is scant, it is clear that women innovated techniques in textile manufacture, metallurgy, and medical sciences. The most extensive engagement of women in science was in medicine, including obstetrics, gynaecology, pharmacology, and dermatology. The evidence for this often comes from male medical writers. Women were also involved in the manufacture of gold alloys, which interested later alchemists. Maria of Alexandria innovated equipment (...) and techniques while also theorizing about chemical change. Many of the works ascribed to women in antiquity were not written by women. However, they do indicate what sorts of sciences were taken to be the province of women. (shrink)

Medical students may fear that their training leeches away the caring attitudes which attracted them to medicine. Some research suggests they are right. The medical school has a duty to support and encourage their values, but the reverse may happen. Students are taught about legal consent but not ethical consent. They may see or participate in concealment of medical mistakes and learn to practise deceit. The use of unconscious females for gynaecology teaching may encourage the wrong attitudes to patients. Trainee (...) GPs may learn that the doctors' rights are more important than those of the patient. Measuring patients' views should be included in research protocols. (shrink)

The wide-ranging content of Places in Man represents the entire Hippocratic Corpus: anatomy, physiology, pathology, medical ideology, clinical instruction, traditional love, gynaecology. Despite this wide and varied scope, the work is conceptually coherent and stylistically consistent. In this new edition of the Greek text with translation and commentary, the language and content of the work are studied in relation to other treatises of the Hippocratic Corpus, and to fragmentary early medical writings. It is argued that while there are `Koan' and (...) `Knidian' elements, a West Greek origin is probable; and that this may be the earliest work in the Corpus. (shrink)

Background: Abortion policy varies significantly between Northern Ireland and Norway. This is the first study to compare medical students’ attitudes towards abortion in two different countries. Objective: To assess medical students’ attitudes to abortion at the University of Oslo (UiO) and Queen’s University Belfast (QUB). Design: An anonymous questionnaire completed by 59 medical students at UiO and 86 medical students at QUB. Participants: Students who had completed their obstetrics and gynaecology placements during 2006/2007. Results: The students’ responses (UiO versus QUB) (...) were as follows: response rate, 95.2% vs 92.5%; stated no religious affiliation, 48.0% vs 4.7%; pro-abortion, 78.2% vs 14.3% (χ2 = 58.160, p<0.001); had seen an abortion while studying medicine, 74.6% vs 9.4% (χ2 = 73.183, p<0.001); in favour of abortion when there was a threat to the mother’s life, 100% vs 93.3% (χ2 = 6.143, p = 0.150); in favour of providing abortion on the mother’s request, 86.4% vs 9.3% (χ2 = 42.067, p<0.001); in agreement that women should have access to free abortion services (mean value on a 5-point Likert scale 1.69 out of 5), versus in disagreement (mean 3.76, p<0.001). Conclusion: There were significant differences in students’ attitudes to abortion, reflecting differences in religious, legal and educational experiences. (shrink)

An examination of the use of medical simulators shows that they contain traces of the one-sex body model found in pre-Enlightenment anatomies. The simulators present the male body as ‘male including female’ rather than ‘male, not female’. Only when female sex organs are relevant to a practice, as in gynaecology, does a simulator need to become ‘female, not male’. The widely held modernist understanding of sex and gender as binary categories is actually masking local practices which allow varied sex and (...) gender paradigms to coexist in simulator use. This analysis applies the discussions of Laqueur, Schiebinger and Faulkner to simulator practice. The consequences of recognizing the presence of the one-sex body are two-fold. Firstly, seeing that the reification of medical knowledge can still be haunted by conceptual paradigms of the past forces a more nuanced understanding of the variety that localized medical practices contain. Secondly, observing the ease with which the reified knowledge of a one-sex body is embraced by subjects who also exist in a world of binary gender points to the complexity our subjectivities can embrace and forces the researcher to acknowledge the implications of the simulations’ context. (shrink)

IntroductionThis special issue brings together researchers from psychology and linguistics who apply the ethnomethodologically informed analytic technique of conversation analysis (henceforth CA) to examine a range of ethical issues as they emerge in transcribed recordings of interactions collected as part of routine research encounters. The data authors analyse are diverse, including naturalistic audio and video recordings of members’ everyday and professional practices (Mondada 2014), an ethnography of a gynaecology unit in a public hospital in Italy (Fatigante and Orletti 2014), focus (...) group interviews on domestic family life (Alby and Fatigante 2014), and semi-public meetings, recorded as part of an ethnography of ageing, poverty, and social exclusion (Paoletti 2014b). Noting that “ethical issues in research have seldom been the focus of ethnomethodological studies” (Paoletti 2014a: 174; see also Mondada 2014: 182–183), the primary aim of this special issue is to “open a debate on e. (shrink)

Objective: To determine the practice in UK hospitals regarding the level of patient involvement and consent when representatives of commercial surgical device manufacturers attend and advise during operations.Methods: An anonymous postal questionnaire was sent to the senior nurse in charge in all 236 UK gynaecology theatres in 2004. 79/236 replies were received.Results: Operating departments were visited every 2 weeks on average by a representative of the surgical device manufacturer. Actual operations were attended every 10 weeks, although there was much variation. (...) 33/79 units consistently obtained patient consent for visits, usually orally, whereas 40/79 units did not. 65/79 units had no guidelines for surgical device representative visits. 91% of nurses in charge believed that there should be guidelines to protect both patients and staff. 6/79 units were preparing local guidelines at the time of the survey.Conclusions: Currently, patient safety, confidentiality and autonomy are being protected by a minority of NHS operating theatres when surgical device representatives attend surgery. National guidelines would hopefully ensure that fully informed patient consent is obtained and that representatives are fully trained and supervised. (shrink)

Background Intersectionality is a concept that originated in Black feminist movements in the US-American context of the 1970s and 1980s, particularly in the work of feminist scholar and lawyer Kimberlé W. Crenshaw. Intersectional approaches aim to highlight the interconnectedness of gender and sexuality with other social categories, such as race, class, age, and ability to look at how individuals are discriminated against and privileged in institutions and societal power structures. Intersectionality is a “traveling concept”, which also made its way into (...) bioethical research. Methods We conducted a systematic review to answer the question of where and how the concept of intersectionality is applied in bioethical research. The PubMed and Web of Science databases were systematically searched and 192 articles addressing bioethical topics and intersectionality were finally included. Results The qualitative analysis resulted in a category system with five main categories: (1) application purpose and function, (2) social dimensions, (3) levels, (4) health-care disciplines and academic fields, and (5) challenges, limitations, and critique. The variety of academic fields and health-care disciplines working with the concept ranges from psychology, through gynaecology to palliative care and deaf studies. Important functions that the concept of intersectionality fulfils in bioethical research are making inequities visible, creating better health data collections and embracing self-reflection. Intersectionality is also a critical praxis and fits neatly into the overarching goal of bioethics to work toward social justice in health care. Intersectionality aims at making research results relevant for respective communities and patients, and informs the development of policies. Conclusions This systematic review is, to the best of our knowledge, the first one to provide a full overview of the reference to intersectionality in bioethical scholarship. It creates a basis for future research that applies intersectionality as a theoretical and methodical tool for analysing bioethical questions. (shrink)

ObjectiveTo evaluate the knowledge and performance of surgical residents regarding the person from whom informed consent should be taken for surgery and from whom the consent is taken in practice.Materials and methodsThis study was done in 2013. The population of this study was all residents of urology, surgery, orthopaedic surgery and gynaecology of Tehran and Iran University of Medical Sciences. The study tool was a self-administered questionnaire, containing questions on their knowledge and performance regarding informed consent acquisition from patients with (...) different conditions in terms of age, sex, marital status and their capacity to make treatment decisions.ResultsA total of 213 residents participated in the study. The mean score of the participants’ knowledge was 72.95 out of 100. There was no significant correlation between the residents’ knowledge and performance. Regarding a competent married male patient, 98.2% of the residents knew that the person’s consent was enough, but only 63.6% obtained informed consent only from the patient. These percentages were 69% and 19.7% for a competent married female patient, respectively. For a competent single male patient, 90.9% of the residents were aware that the patient’s consent was enough, while only 40% of the residents obtained informed consent only from the patient. These percentages were 65.3% and 16% for a competent single female patient, respectively.ConclusionDespite the residents’ average knowledge of patient autonomy, this right is not observed for female patients, and their treatment is subject to consent acquisition from other family members. (shrink)

This study aims to describe and compare nurses' willingness to provide care for patients with HIV/AIDS and factors associated with this in three countries. An international cross-sectional survey was conducted among nurses working in medical, surgical and gynaecology units in Finland (n =427), Estonia (n =221) and Lithuania ( n =185) in early 2006. The response rates were 75% (n = 322) in Finland, 54% (n =119) in Estonia and 86% (n = 160) in Lithuania. A modified version of a (...) scale developed in 1994 by Dubbert et al. was applied. Our findings showed a general willingness of the nurse participants to provide care for patients with HIV/AIDS. However, this willingness varied both among and within countries and was also related to specific nursing interventions. The results underline the importance of providing education on ethical issues related to HIV/AIDS care in Europe and tailoring the content of this education to meet nurses' national educational needs. (shrink)

The concept of reproductive health promises to play a crucial role in improving health care provision and legal protection for women around the world. This is an authoritative and much-needed introduction to and defence of the concept of reproductive health, which though internationally endorsed, is still contested. The authors are leading authorities on reproductive medicine, women's health, human rights, medical law, and bioethics. They integrate their disciplines to provide an accessible but comprehensive picture. They analyse 15 cases from different countries (...) and cultures, and explore options for resolution. The aim is to equip readers to fashion solutions in their own health care circumstances, compatibly with ethical, legal and human rights principles. (shrink)