Sartwelle Thomas P, Johnston James C, Arda Berna
Deans and Lyons, LLP, Houston, TX USA.
1150 N Loop 1604 W, Ste 108-625, San Antonio, TX 98110 USA.
Matern Health Neonatol Perinatol. 2017 Nov 21;3:21. doi: 10.1186/s40748-017-0060-2. eCollection 2017.
Bioethics abolished the prevailing Hippocratic tenet instructing physicians to make treatment decisions, replacing it with autonomy through informed consent. Informed consent allows the patient to choose treatment after options are explained by the physician. The appearance of bioethics in 1970 coincided with the introduction of electronic fetal monitoring (EFM), which evolved to become the fetal surveillance modality of choice for virtually all women in labor. Autonomy rapidly pervaded all medical procedures, but there was a clear exemption for EFM. Even today, EFM remains immune to the doctrine of informed consent despite continually mounting evidence which proves the procedure is nothing more than myth, illusion and junk science that subjects mothers and babies alike to increased risks of morbidity and mortality. And ethicists have remained utterly silent through a half century of EFM misuse. Our article explores this egregious ethical failure by reviewing EFM's lack of clinical efficacy, discussing the EFM related harm to mothers and babies, and focusing on the reasons that this obstetrical procedure eluded the revolutionary change from the Hippocratic tradition to autonomy through informed consent.
生物伦理学摒弃了希波克拉底的主流信条，该信条指导医生做出治疗决策，代之以通过知情同意实现的自主权。知情同意使患者能够在医生解释各种选择后选择治疗方案。1970年生物伦理学的出现恰逢电子胎儿监护（EFM）的引入，EFM逐渐发展成为几乎所有分娩女性首选的胎儿监测方式。自主权迅速渗透到所有医疗程序中，但EFM却是个明显的例外。即使在今天，尽管越来越多的证据表明EFM不过是神话、幻觉和伪科学，会增加母婴发病和死亡的风险，但EFM仍然不受知情同意原则的约束。在EFM被滥用的半个世纪里，伦理学家一直完全沉默。我们的文章通过回顾EFM缺乏临床疗效、讨论EFM对母婴的相关危害，并着重探讨这一产科程序为何能避开从希波克拉底传统到通过知情同意实现自主权这一革命性变革，来探究这种极其严重的伦理失败。
