Fleischman A R, Rhoden N K
Department of Pediatrics, Albert Einstein College of Medicine-Montefiore Medical Center, Bronx, New York.
Obstet Gynecol. 1988 May;71(5):790-5.
Advances in perinatal medicine have increased the complexity of the clinical decision-making process. Medical education curricula have paid little attention to exploring the ethical and legal aspects of these decisions. In response to this perceived need, we initiated a case-oriented teaching program in perinatal law and ethics. The goals of the program included the following: to develop skills in "moral diagnosis" and analysis (the ability to interpret and analyze clinical cases from a moral point of view); to understand the relevant laws; to appreciate the ethical and legal relationships between the pregnant woman, her fetus, and the professionals; and to encourage open and frank discussion of these important issues. The teaching rounds, led by a lawyer and ethicist, were held monthly, and included all professionals who care for pregnant women and their newborns. A patient was presented in lay language, stressing the ethical or legal issue raised by the case. Cases could be separated into five categories: questions concerning abortion, issues of maternal-fetal conflict, labor management in extreme prematurity or fetal abnormality, innovative therapy, and the psychological concerns of difficult decisions. Careful case analysis with an in-depth discussion of the ethical principles and legal precedents on which decisions are based appears to be an effective and useful educational exercise. This approach to perinatal teaching can prepare professionals to deal with exigent situations that may occur in practice.
围产期医学的进步增加了临床决策过程的复杂性。医学教育课程很少关注探讨这些决策的伦理和法律方面。为了回应这种已被察觉到的需求，我们启动了一个以案例为导向的围产期法律与伦理教学项目。该项目的目标包括以下几点：培养“道德诊断”和分析能力（即从道德角度解读和分析临床案例的能力）；了解相关法律；认识孕妇、胎儿与专业人员之间的伦理和法律关系；鼓励对这些重要问题展开坦诚开放的讨论。由一名律师和一名伦理学家主持的教学查房每月举行一次，参与人员包括所有照顾孕妇及其新生儿的专业人员。用通俗易懂的语言介绍一个病例，强调该病例引发的伦理或法律问题。病例可分为五类：关于堕胎的问题、母胎冲突问题、极早产儿或胎儿异常情况下的分娩管理、创新疗法以及艰难决策带来的心理问题。对病例进行仔细分析，并深入讨论决策所依据的伦理原则和法律先例，这似乎是一种有效且有用的教育方式。这种围产期教学方法能够让专业人员做好准备，应对实际工作中可能出现的紧急情况。
