Department of Health, College of Health Sciences, West Chester University, West Chester, Pennsylvania.
J Midwifery Womens Health. 2020 Nov;65(6):789-794. doi: 10.1111/jmwh.13144. Epub 2020 Aug 6.
Multiple types of midwives practice in the United States, but regulation of midwifery practice varies by state. In some states, direct entry midwifery practice is unregulated or criminalized. Because regulations are the most burdensome of the public health interventions, they require the most stringent ethical critique. This article uses the most recent Public Health Code of Ethics to analyze the ethics of regulations that criminalize direct entry midwifery practice. The Code establishes 8 criteria for ethical actions: (1) permissibility, (2) respect, (3) reciprocity, (4) effectiveness, (5) responsible use of scarce resources, (6) proportionality, (7) accountability and transparency, and (8) public participation. Laws that criminalize direct entry midwifery practice violate all of these criteria and therefore cannot be considered an ethical approach to the state's duty to safeguard public health. The remedy for this problem is for all states to license and regulate all types of midwives that meet international standards of education and training.
美国有多种类型的助产士，但各州的助产士实践管理规定各不相同。在一些州，直接入行的助产士实践不受监管或被定为犯罪。由于监管是最繁重的公共卫生干预措施，因此需要最严格的伦理审查。本文使用最新的《公共卫生道德规范》来分析将直接入行的助产士实践定为犯罪的监管规定的伦理问题。该规范确立了八项伦理行动标准：（1）允许性，（2）尊重，（3）互惠，（4）有效性，（5）负责任地使用稀缺资源，（6）相称性，（7）问责制和透明度，（8）公众参与。将直接入行的助产士实践定为犯罪的法律违反了所有这些标准，因此不能被视为履行国家保障公共卫生职责的一种合乎道德的方法。解决这个问题的办法是，所有州都应向符合国际教育和培训标准的所有类型的助产士颁发许可证并对其进行监管。
