Sharp E S
University of Michigan, USA.
J Nurse Midwifery. 1998 May-Jun;43(3):235-45. doi: 10.1016/s0091-2182(98)00011-1.
Knowledge and technologic advancements have created a myriad of new screening, diagnostic, and treatment options for women of reproductive age. These new options often raise ethical issues as the women, their health care professionals, and society adapt to the benefits while coping with the pressures and burdens these options create. Threats to accomplishing the good that midwifery strives to contribute to health care for the benefit of women are identified from the perspective of the midwife's instrumental and expressive roles. Suggestions are presented for resolving ethical dilemmas that may occur in the selection and implementation of health care options. A distinction is made between midwifery practice at the microlevel, which achieves the good through direct interaction with the woman, and the institutional macrolevel that promotes accomplishing the good in reproductive health care through policy developmental and management decisions.
知识和技术进步为育龄女性带来了无数新的筛查、诊断和治疗选择。随着女性、她们的医疗保健专业人员以及社会在享受这些选择带来的益处的同时，应对这些选择所带来的压力和负担，这些新选择常常引发伦理问题。从中助产士的工具性和表达性角色的角度，识别出了对实现助产士努力为女性健康保健做出贡献的善举的威胁。针对在选择和实施医疗保健选择时可能出现的伦理困境，提出了相关建议。区分了微观层面的助产实践，即通过与女性直接互动来实现善举，以及宏观层面的机构层面，即通过政策制定和管理决策来促进在生殖健康保健中实现善举。
