Division of Gender and Medicine, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
Eur J Obstet Gynecol Reprod Biol. 2012 Nov;165(1):18-28. doi: 10.1016/j.ejogrb.2012.07.018. Epub 2012 Aug 17.
In obstetrical and gynaecological healthcare, patients often find themselves in a vulnerable position. Sensitive issues such as sexual and reproductive health are addressed and certain procedures can be experienced as abusive. According to research a lifetime prevalence of abuse in healthcare (AHC) can be assumed for 13-28% of female patients in the Nordic countries. In the present study we analyse the content of ethical documents for healthcare professionals within obstetrics and gynaecology in Sweden, in order to find out to what extent ethical guidelines consider issues that have shown to be related to the occurrence of AHC.
We searched the literature to find empirical data on AHC. Guidelines for nurses, midwives and physicians were selected. After developing an analytical framework based on the empirical data the content of the ethical guidelines was analysed.
The various ethical guidelines for staff working within obstetrics and gynaecology differ distinctively from each other regarding their content of issues that are related to AHC. Issues that were mostly disregarded were: considering the patient's perspective and the patients' possible experience of violence, considering power imbalances within healthcare, sexual misconduct, how to deal with other professional's ethical misconduct and how professionals relate to each other. We found the ethical guidelines of the International Federation of Gynecology and Obstetrics (FIGO) and of the International Confederation of Midwives to be those which contained most of the issues that have empirically shown to be important in regard to AHC.
While staff members from different professions may share responsibility for the same patient, their ethical guidelines vary considerably. To become a possible resource for prevention of AHC, we suggest that ethical guidelines in healthcare should be revised following empirical research on ethical conduct. As ethical guidelines cannot be effective by their existence only, we would like to initiate a discussion on the function and use of ethical guidelines in general and regarding AHC in particular. Being aware that ethical guidelines are only a part of ethics in healthcare, however, we envision a broader approach to the aim of preventing AHC, where research is encouraged on how a virtue ethics approach could be applied.
在妇产科保健中，患者常常处于弱势地位。涉及到性健康和生殖健康等敏感问题，某些程序可能会被视为虐待。根据研究，北欧国家 13-28%的女性患者一生中可能会遭受医疗保健中的虐待（AHC）。在本研究中，我们分析了瑞典妇产科医疗保健专业人员的伦理文件的内容，以了解伦理准则在多大程度上考虑了与 AHC 发生相关的问题。
我们搜索文献以查找 AHC 的实证数据。选择了护士、助产士和医生的准则。在基于实证数据制定分析框架之后，我们分析了伦理准则的内容。
不同的妇产科工作人员的各种伦理准则在与 AHC 相关的问题内容上存在明显差异。被忽略的问题主要包括：考虑患者的观点和患者可能遭受暴力的经历、考虑医疗保健中的权力失衡、性行为不端、如何处理其他专业人员的道德不当行为以及专业人员之间的关系。我们发现国际妇产科联合会（FIGO）和国际助产士联合会（ICM）的伦理准则包含了大多数经验表明与 AHC 相关的重要问题。
尽管不同专业的工作人员可能对同一患者负有共同责任，但他们的伦理准则却有很大差异。为了成为预防 AHC 的可能资源，我们建议根据有关伦理行为的实证研究修订医疗保健中的伦理准则。由于仅存在伦理准则并不能使其有效，我们希望就伦理准则的功能和使用展开讨论，特别是关于 AHC。但是，我们意识到伦理准则只是医疗保健伦理的一部分，我们设想了一种更广泛的方法来预防 AHC，鼓励研究如何应用美德伦理学方法。
