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Committee Opinion Number 759, November 2018

(Replaces Committee Opinion No. 466, September 2010)

ABSTRACT: Global surgical care programs present obstetrician–gynecologists with important opportunities to address disparities in women’s health and health care worldwide. However, these programs also present a unique set of practical and ethical challenges. Obstetrician–gynecologists are encouraged to participate in surgical care efforts abroad while taking the necessary steps to ensure that their patients can make informed decisions and receive benefit from and are not harmed by their surgical care. In this document, the Committee on Ethics highlights some of the ethical issues that may ari...


Committee Opinion Number 724, November 2017

(Replaces Committee Opinion Number 409, June 2008;
Committee Opinion Number 488, May 2011;
and Committee Opinion Number 527, June 2012)
(Reaffirmed 2019)

ABSTRACT: With the increased emphasis on patient-driven health care and readily available access to patients through the internet and media, many genetic testing companies have begun to market directly to consumers. Direct-to-consumer genetic testing raises unique concerns and considerations, including limited knowledge among patients and health care providers of available genetic tests, difficulty in interpretation of genetic test results, lack of oversight of companies that offer genetic testing, and issues of privacy and confidentiality. When undergoing any direct-to-consumer genetic testi...


Committee Opinion Number 691, March 2017

(Replaces Committee Opinion Number 318, October 2005;
Committee Opinion Number 432, May 2009;
Committee Opinion Number 442, October 2009;
Committee Opinion Number 469, October 2010;
Committee Opinion Number 486, April 2011)

(Reaffirmed 2019)

ABSTRACT: Carrier screening is a term used to describe genetic testing that is performed on an individual who does not have any overt phenotype for a genetic disorder but may have one variant allele within a gene(s) associated with a diagnosis. Information about carrier screening should be provided to every pregnant woman. Carrier screening and counseling ideally should be performed before pregnancy because this enables couples to learn about their reproductive risk and consider the most complete range of reproductive options. A patient may decline any or all screening. When an individual is ...


Committee Opinion Number 665, June 2016

(Reaffirmed 2018)

ABSTRACT: Considerable uncertainty exists about what constitutes appropriate levels of protection for adolescents as research participants and about the need for parental permission. The ethical principles that govern research include respect for individuals, beneficence, and justice, as articulated in the Belmont Report. Researchers should be familiar with and adhere to current federal regulations 45 C.F.R. § 46, and federal and state laws that affect research with minors. Investigators should understand the importance of caregiver permission—and ethically appropriate situations in which to ...


Committee Opinion Number 664, June 2016

(Replaces Committee Opinion Number 321, November 2005)

ABSTRACT: One of the most challenging scenarios in obstetric care occurs when a pregnant patient refuses recommended medical treatment that aims to support her well-being, her fetus’s well-being, or both. In such circumstances, the obstetrician–gynecologist’s ethical obligation to safeguard the pregnant woman’s autonomy may conflict with the ethical desire to optimize the health of the fetus. Forced compliance—the alternative to respecting a patient’s refusal of treatment—raises profoundly important issues about patient rights, respect for autonomy, violations of bodily integrity, power diffe...


Committee Opinion Number 646, November 2015

(Replaces Committee Opinion No. 307, December 2004
and Committee Opinion No. 377, September 2007)
(Reaffirmed 2018)

ABSTRACT: Inclusion of women in research studies is necessary for valid inferences about health and disease in women. The generalization of results from trials conducted in men may yield erroneous conclusions that fail to account for the biologic differences between men and women. Although significant changes in research design and practice have led to an increase in the proportion of women included in research trials, knowledge gaps remain because of a continued lack of inclusion of women, especially those who are pregnant, in premarketing research trials. This document provides a historical...


Committee Opinion Number 633, June 2015

(Replaces Committee Opinion Number 422, December 2008) (Reaffirmed 2018)

ABSTRACT: Alcohol abuse and other substance use disorders are major, often underdiagnosed health problems for women, regardless of age, race, ethnicity, and socioeconomic status, and have resulting high costs for individuals and society. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, defines substance use disorder as a pathologic pattern of behaviors related to the use of any of 10 separate classes of substances, including alcohol and licit and illicit substances. In order to optimize care of patients with substance use disorder, obstetrician–gynecologists are encou...


Committee Opinion Number 624, February 2015

Reaffirmed 2019

ABSTRACT: Cytology-based cervical cancer screening programs require a number of elements to be successful. Certain low-resource settings, like the U.S. Affiliated Pacific Islands, lack these elements. Implementing alternative cervical cancer screening strategies in low-resource settings can provide consistent, accessible screening opportunities.


9.
January 2015

Committee Opinion Number 617, January 2015

(Replaces Committee Opinion Number 403, April 2008) (Reaffirmed 2018)

ABSTRACT: Obstetrician–gynecologists care for women throughout their lifespans and are in an ideal position to have ongoing discussions with healthy patients about their values and wishes regarding future care and to encourage them to complete an advance directive for health care. In addition, situations may arise in which obstetrician–gynecologists need to participate in end-of-life care. When end-of-life decisions need to be made while a woman is pregnant, the level of ethical complexity often is increased. The purpose of this Committee Opinion is to discuss ethical issues related to end-of...


Statement of Policy (Reaffirmed July 2014), July 2014

The problem of perinatal transmission of HIV infection was first appreciated in 1982. In 1991, the Institute of Medicine (IOM) recommended a policy of routine counseling and offering testing (with specific informed consent) for HIV infection to all pregnant women. Since 1991, there have been major advances in the treatment of HIV infection, including demonstration in 1994 of the efficacy of zidovudine to reduce perinatal transmission. The U.S. Public Health Service subsequently issued guidelines for use of zidovudine to reduce perinatal transmission and for counseling and voluntary testing fo...


Committee Opinion Number 578, November 2013

(Reaffirmed 2016. Replaces No. 395, January 2008)

ABSTRACT: Acknowledgment of the importance of patient autonomy and increased patient access to information, such as information on the Internet, has prompted more patient-generated requests for surgical interventions not traditionally recommended. Depending on the context, acceding to a request for a surgical option that is not traditionally recommended can be ethical. Decisions about acceding to patient requests for nontraditional surgical interventions should be based on strong support for patients’ informed preferences and values; understood in the context of an interpretive conversation; ...


(Reaffirmed July 2016)

The American College of Obstetricians and Gynecologists and the American Congress of Obstetricians and Gynecologists find the targeting of women of all ages by the tobacco industry unconscionable and strongly oppose the practice.


Approved by the Executive Board May 2013; Revised and reaffirmed

Government serves a valuable role in the protection of public health and safety and the provision of essential health services. The American College of Obstetricians and Gynecologists (the College) and the American Congress of Obstetricians and Gynecologists (ACOG) support this proper role of government. Laws that veer from these functions and unduly interfere with patient-physician relationships are not appropriate. Absent a substantial public.


Statement of Policy (Approved by the Executive Board July 2012), July 2012

Acknowledging the significant interplay of women's human rights with the overall health of women and society, the American College of Obstetricians and Gynecologists and the American Congress of Obstetricians and Gynecologists (ACOG) ardently support efforts to improve the dignity, autonomy, rights and health of women in the United States and globally.


15.
June 2012

Committee Opinion Number 528, June 2012

(Replaces No. 368, June 2007) (Reaffirmed 2018)

ABSTRACT: Obstetrician–gynecologists may find themselves at the center of adoption issues because of their expertise in the assessment and management of infertility, pregnancy, and childbirth. The lack of clarity about both ethical issues and legal consequences may create challenges for physicians. Therefore, the Committee on Ethics of the American College of Obstetricians and Gynecologists discusses ethical issues, proposes safeguards, and makes recommendations regarding the role of the physician in adoption.


Committee Opinion Number 501, August 2011

(Reaffirmed 2017)

ABSTRACT: The past two decades have yielded profound advances in the fields of prenatal diagnosis and fetal intervention. Although fetal interventions are driven by a beneficence-based motivation to improve fetal and neonatal outcomes, advancement in fetal therapies raises ethical issues surrounding maternal autonomy and decision making, concepts of innovation versus research, and organizational aspects within institutions in the development of fetal care centers. To safeguard the interests of both the pregnant woman and the fetus, the American College of Obstetricians and Gynecologists and t...


Committee Opinion Number 480, March 2011

Reaffirmed 2017

ABSTRACT: Empathy is the process through which one attempts to project oneself into another's life and imagine a situation from his or her point of view. Most individuals do have an innate capacity to show empathy toward others. Empathy is as important to being a good physician as technical competence. However, at times the health care environment and educational process overly emphasize technological competence, curing disease rather than healing the patient, or the economic aspects of medicine. This may interfere with an empathic approach in the clinical setting. In this Committee Opinion, ...


Committee Opinion Number 456, March 2010

(Reaffirmed 2017)

ABSTRACT: In this Committee Opinion, the Committee on Ethics of the American College of Obstetricians and Gynecologists endorses the College's ongoing efforts to promote a just health care system, explores justifications that inform just health care, and identifies professional responsibilities to guide the College and its members in advancing the cause of health care reform.


19.
August 2009

Committee Opinion Number 439, August 2009

(Reaffirmed 2015)

ABSTRACT: Obtaining informed consent for medical treatment, for participation in medical research, and for participation in teaching exercises involving students and residents is an ethical requirement that is partially reflected in legal doctrines and requirements. As an ethical doctrine, informed consent is a process of communication whereby a patient is enabled to make an informed and voluntary decision about accepting or declining medical care. In this Committee Opinion, the American College of Obstetricians and Gynecologists' Committee on Ethics describes the history, ethical basis, and ...


Committee Opinion Number 410, June 2008

(Reaffirmed 2014)

ABSTRACT: Genetic testing is poised to play an increasing role in the practice of obstetrics and gynecology. To assure patients of the highest quality of care, physicians should become familiar with the currently available array of genetic tests and the tests' limitations. Clinicians should be able to identify patients within their practices who are candidates for genetic testing. Candidates will include patients who are pregnant or considering pregnancy and are at risk for giving birth to affected children as well as gynecology patients who, for example, may have or be predisposed to certain...


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