Ethics in Obstetrics and Gynecology, Second Edition -- Preface

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Dedication

Preface

Part I
Ethical Foundations

"Ethical Decision Making in Obstetrics and Gynecology" in Ethics in Obstetrics and Gynecology, Second Edition, has been removed from the website. An updated version has been released as Committee Opinion #390 "Ethical Decision Making in Obstetrics and Gynecology".

Informed Consent

Part II
Caring for Patients

"Surgery and Patient Choice" in Ethics in Obstetrics and Gynecology, Second Edition, has been removed from the website. An updated version has been released as Committee Opinion #395 "Surgery and Patient Choice".

"Patient Testing" in Ethics in Obstetrics and Gynecology, Second Edition, has been removed from the website. An updated version has been released as Committee Opinion #363 "Patient Testing: Ethical Issues in Selection and Counseling".

Committee Opinion #410 "Ethical Issues in Genetic Testing" has been issued since the publication of Ethics in Obstetrics and Gynecology, Second Edition.

Committee Opinion #409 "Direct-to-Consumer Marketing of Genetic Testing" has been issued since the publication of Ethics in Obstetrics and Gynecology, Second Edition.

"Human Immunodeficiency Virus" in Ethics in Obstetrics and Gynecology, Second Edition, has been removed from the website. An updated version has been released as Committee Opinion #389 "Human Immunodeficiency Virus".

Committee Opinion #422 "At-Risk Drinking and Illicit Drug Use: Ethical Issues in Obstetric and Gynecologic Practice" has been issued since the publication of Ethics in Obstetrics and Gynecology, Second Edition.

Committee Opinion #385 "The Limits of Conscientious Refusal in Reproductive Medicine" has been issued since the publication of Ethics in Obstetrics and Gynecology, Second Edition.

Patient Choice in the Maternal-Fetal Relationship

Committee Opinion #321 "Maternal Decision Making, Ethics and the Law" has been issued since the publication of Ethics in Obstetrics and Gynecology, Second Edition.

"Sex Selection" in Ethics in Obstetrics and Gynecology, Second Edition, has been removed from the website. An updated version has been released as Committee Opinion #360 "Sex Selection".

"Multifetal Pregnancy Reduction" in Ethics in Obstetrics and Gynecology, Second Edition, has been removed from the website. An updated version has been released as Committee Opinion #369 "Multifetal Pregnancy Reduction".

"Adoption" in Ethics in Obstetrics and Gynecology, Second Edition, has been removed from the website. An updated version has been released as Committee Opinion #368 "Adoption".

"Surrogate Motherhood" in Ethics in Obstetrics and Gynecology, Second Edition, has been removed from the website. An updated version has been released as Committee Opinion #397 "Surrogate Motherhood".

Committee Opinion #297 "Nonmedical Use of Obstetric Ultrasonography" has been issued since the publication of Ethics in Obstetrics and Gynecology, Second Edition.

"Sterilization of Women, Including Those with Mental Disabilities" in Ethics in Obstetrics and Gynecology, Second Edition, has been removed from the website. An updated version has been released as Committee Opinion #371 "Sterilization of Women, Including Those with Mental Disabilities".

"End-of-Life Decision Making" in Ethics in Obstetrics and Gynecology, Second Edition, has been removed from the website. An updated version has been released as Committee Opinion #403 "End-of-Life Decision Making".

"Medical Futility" in Ethics in Obstetrics and Gynecology, Second Edition, has been removed from the website. An updated version has been released as Committee Opinion #362 "Medical Futility".

Part III
Professional Responsibilities

"Obstetric-Gynecologic Education" in Ethics in Obstetrics and Gynecology, Second Edition, has been removed from the website. An updated version has been released as Committee Opinion #358 "Professional Responsibilities in Obstetric-Gynecologic Education".

"Seeking and Giving Consultation" in Ethics in Obstetrics and Gynecology, Second Edition, has been removed from the website. An updated version has been released as Committee Opinion #365 "Seeking and Giving Consultation".

"Institutional Responsibility to Provide Legal Representation" in Ethics in Obstetrics and Gynecology, Second Edition, has been removed from the website. An updated version has been released as Committee Opinion #370 "Institutional Responsibility to Provide Legal Representation".

"Commercial Enterprises in Medical Practice" in Ethics in Obstetrics and Gynecology, Second Edition, has been removed from the website. An updated version has been released as Committee Opinion #359 "Commercial Enterprises in Medical Practice".

Committee Opinion #341 "Ethical Ways for Physicians to Market a Practice" has been issued since the publication of Ethics in Obstetrics and Gynecology, Second Edition.

Committee Opinion #352 "Innovative Practice: Ethical Guidelines" has been issued since the publication of Ethics in Obstetrics and Gynecology, Second Edition.

"Research Involving Women" in Ethics in Obstetrics and Gynecology, Second Edition, has been removed from the website. An updated version has been released as Committee Opinion #377 "Research Involving Women".

"Preembryo Research" in Ethics in Obstetrics and Gynecology, Second Edition, has been removed from the website. An updated version has been released as Committee Opinion 347 "Using Preimplantation Embryos for Research".

"Sexual Misconduct" in Ethics in Obstetrics and Gynecology, Second Edition, has been removed from the website. An updated version has been released as Committee Opinion #373 "Sexual Misconduct".

Part IV
Societal Responsibilities

"Relationships with Industry" in Ethics in Obstetrics and Gynecology, Second Edition, has been removed from the website. An updated version has been released as Committee Opinion #401 "Relationships with Industry".

"Patents, Medicine, and the Interests of Patients" in Ethics in Obstetrics and Gynecology, Second Edition, has been removed from the website. An updated version has been released as Committee Opinion #364 "Patents, Medicine, and the Interests of Patients".

"Expert Testimony" in Ethics in Obstetrics and Gynecology, Second Edition, has been removed from the website. An updated version has been released as Committee Opinion #374 "Expert Testimony".

Code of Professional Ethics of the American College of Obstetricians and Gynecologists

Copyright © 2004 by the American College of Obstetricians and Gynecologists, 409 12th Street, SW, PO Box 96920, Washington, DC 20090-6920. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without prior written permission from the publisher.

ISBN 1-932328-03-3

Copies of Ethics in Obstetrics and Gynecology can be ordered through the ACOG Distribution Center by calling toll free 800-762-2264. Orders also can be placed from the ACOG web site at www.acog.org or sales.acog.org.

Preface

The purpose of the second edition of Ethics in Obstetrics and Gynecology is to help obstetrician-gynecologists understand and apply the concepts of biomedical ethics to problems in clinical practice, research, and the provision of health care in the community. As the chapters reflect, these professional areas frequently intersect. However, for ease of use, this edition has been reorganized so that related ethical obligations are grouped together. Part I, "Ethical Foundations," describes various theoretical approaches to ethical decision making, offers a stepwise guideline for decision making, addresses common issues faced in daily practice, and offers detailed information on the rationale for obtaining the informed consent of patients and practical assistance as to how this is done. Part II, "Caring for Patients," provides ethical guidance for obstetrician-gynecologists in providing specific health services to their patients. Part III, "Professional Responsibilities," speaks to the ethical obligations that arise out of obstetrician-gynecologists' nonclinical duties as students, teachers, and researchers. This part also identifies appropriate interactions with patients expected as a part of professional behavior. Part IV, "Societal Responsibilities," addresses the ethical obligations of obstetrician-gynecologists to society.

This edition of Ethics in Obstetrics and Gynecology adds the following new chapters originally published in 2002 and 2003 as Committee Opinions issued by the Committee on Ethics of the American College of Obstetricians and Gynecologists (ACOG):

Patents, Medicine, and the Interests of Patients (originally published with ACOG's Committee on Genetics as "Patents, Medicine, and the Interests of Patients: Applying General Principles to Gene Patenting," No. 277, November 2002)

Research Involving Women (originally published as "Ethical Considerations in Research Involving Women," No. 290, November 2003)

Surgery and Patient Choice (originally published as "Surgery and Patient Choice: The Ethics of Decision Making," No. 289, November 2003)

Substantial changes to the content have been made to the following chapters for this edition:

In Part I: Informed Consent
In Part II: Human Immunodeficiency Virus; Patient Choice in the Maternal-Fetal Relationship; Sex Selection; Multifetal Pregnancy Reduction; Adoption; Sterilization of Women, Including Those With Mental Disabilities; End-of-Life Decision Making
In Part III: Obstetric-Gynecologic Education
In Part IV: Relationships With Industry; Expert Testimony

Readers should note that the following chapters from the first edition have been withdrawn because they are no longer current and no longer reflect ACOG policy:

Endorsement of Institutional Ethics Committees
Physician Responsibility Under Managed Care: Patient Advocacy in a Changing Health Care Environment

Ethics in Obstetrics and Gynecology also includes the revised "Code of Professional Ethics of the American College of Obstetricians and Gynecologists," issued January 2004. It is an excellent guide for the specialty of obstetrics and gynecology and appears in the appendix.

The Committee on Ethics wishes to acknowledge the assistance of Michael K. Lindsay, MD, for writing the chapter "Research Involving Women" and his previous leadership of the committee.

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