Department of Obstetrics and Gynecology, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.
Department of Perinatology, Cerrahpaşa Medical School, University of Istanbul, Istanbul, Turkey.
J Perinat Med. 2020 Nov 26;48(9):867-873. doi: 10.1515/jpm-2020-0329.
The goal of perinatal medicine is to provide professionally responsible clinical management of the conditions and diagnoses of pregnant, fetal, and neonatal patients. The New York Declaration of the International Academy of Perinatal Medicine, "Women and children First - or Last?" was directed toward the ethical challenges of perinatal medicine in middle-income and low-income countries. The global COVID-19 pandemic presents common ethical challenges in all countries, independent of their national wealth. In this paper the World Association of Perinatal Medicine provides ethics-based guidance for professionally responsible advocacy for women and children first during the COVID-19 pandemic. We first present an ethical framework that explains ethical reasoning, clinically relevant ethical principles and professional virtues, and decision making with pregnant patients and parents. We then apply this ethical framework to evidence-based treatment and its improvement, planned home birth, ring-fencing obstetric services, attendance of spouse or partner at birth, and the responsible management of organizational resources. Perinatal physicians should focus on the mission of perinatal medicine to put women and children first and frame-shifting when necessary to put the lives and health of the population of patients served by a hospital first.
围产医学的目标是为孕妇、胎儿和新生儿患者提供专业负责的临床管理，以处理各种情况和诊断。《国际围产医学学会纽约宣言》“妇女和儿童优先——还是最后？”旨在应对中低收入国家围产医学面临的伦理挑战。全球 COVID-19 大流行在所有国家都带来了共同的伦理挑战，而不论其国家财富如何。在本文中，世界围产医学会为 COVID-19 大流行期间专业地倡导妇女和儿童优先提供了基于伦理的指导。我们首先介绍了一个伦理框架，该框架解释了伦理推理、与临床相关的伦理原则和职业道德以及对孕妇和父母的决策。然后，我们将该伦理框架应用于基于证据的治疗及其改进、计划的家庭分娩、产科服务的隔离、配偶或伴侣的分娩陪伴以及组织资源的负责任管理。围产医生应专注于围产医学的使命，即把妇女和儿童放在首位，并在必要时进行框架转换，将医院所服务的患者群体的生命和健康放在首位。
