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Ethics and the midwife

As part of the continuing branch review, the third professional discussion forum, entitled `Ethics and the midwife', was held in  the West Midlands. The day provided much opportunity for debate and discussion, as Lianne Brooks reports.  

 

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Midwives magazine: April 2005

  

The third professional discussion forum took place recently and midwives from the West Midlands region came together to discuss `Ethics and the midwife'. The subject was introduced with presentations by members of the RCM ethics committee. This consists of RCM members from varying backgrounds who serve for three years. Their role is to advise the RCM Council on ethical matters and help formulate the RCM's position on these issues.

 

 Gail Johnson from Homerton School of Health Studies gave an informative and thoughtful presentation on `Wrongful birth/wrongful life'. Wrongful birth is defined as when the mother could (technically) sue healthcare services for the birth of a disabled child, where the disability could have been avoided. In a case of wrongful life, it is the child who could potentially sue the mother or others for allowing their birth as his/her life is `not worth living'.

 

This created debate about what makes life valuable and what degree of disability, impairment and suffering is acceptable. Can or should screening be offered to eliminate or reduce disability, and who decides?

 

Julie Wray from the University of Salford then presented the question of how much choice women should have in maternity care. She asked the audience: `Choice - it is out there, but is it equal and does everybody get the same opportunity? `Is the choice offered often dependent on the judgements, both positive and negative, we as midwives make of women? In whose interest do we offer choice and do we make assumptions about what is best? Do we underestimate women's abilities to balance decisions, and do we understand the issue of choice and its relationship with regard to guilt?'

 

 Professor Shirley Jones from the University of Central England introduced the contentious subject of stem cell collection. She reiterated the reasons why both the RCM and British Medical Association are against this, with reference to the RCM position paper on the subject (RCM, 2002). The presentation generated a lot of debate, as a number of midwives felt they had been pressurised into obtaining samples.

 

Lastly, Janet Faulkner from the University of Manchester talked about ethical issues in neonatal care and posed some interesting questions around how much we respect our neonates' dignity and privacy. Would it be acceptable to undress or perform invasive procedures on an older child or adult in full view of the ward? Janet went on to discuss the issues of non-maleficence (do no harm), beneficence (who benefits) and the dilemma of telling the truth when we do not know the outcomes.

 

The delegates then broke up into groups to discuss the suggested scenarios and any other ethical issues they wished to share, and some interesting points were raised One possible scenario for discussion is shown in Box 1. A number of the groups talked about normal versus perfect and the fact that what is normal to one person may not be for someone else. Also, if there are no right or wrong answers, who wins the ethical debate? The person with the most reasoned argument or the person with the loudest voice? How can we assist the midwife who supports a couple in making a difficult choice? All agreed that in future many more midwives will be placed in the difficult position of giving support as antenatal screening becomes more advanced and more widely available.

 

The forum agreed that discussing ethical dilemmas can be difficult and often midwives do not have time to challenge beliefs or the appropriate forum in which to do so.

 

At the end of the day, participants were asked to evaluate the session. Comments included:

  • The forum raised awareness about ethical issues and encouraged reflection

  • There was lively discussion

  • It gave me something to think about

  • The best thing was having a presentation from people who specialise or have a special interest in the topic.

 

If you have an issue that you wish to discuss with a member of the RCM ethics committee, please contact Anne-Marie O'Neill, senior secretary, RCM UK Board for Northern Ireland, on Tel: 02890 241531 or email: aoneill@rcmnib.org.uk

 

Reference

RCM. (2002) Position statement number one: commercial cord blood collection. RCM: London.