Tensions Between Ethics and the Law: Examination of a Legal Case by Two Midwives Invoking a Conscientious Objection to Abortion in Scotland

This paper examines a legal case arising from a workplace grievance that progressed to being heard at the UK's Supreme Court. The case of Doogan and Wood versus Greater Glasgow and Clyde Health Board concerned two senior midwives in Scotland, both practicing Roman Catholics, who exercised their perceived rights in accordance with section 4(1) of the Abortion Act not to participate in the treatment of women undergoing abortions. The key question raised by this case was: "Is Greater Glasgow and Clyde Health Board entitled to require the midwives to delegate, supervise and support staff in the treatment of patients undergoing termination of pregnancy?" The ethical issues concerning conscientious objection to abortion have been much debated although the academic literature is mainly concerned with the position of medical practitioners rather than what the World Health Organization terms "mid-level professionals" such as midwives. This paper examines the arguments put forward by the midwives to justify their refusal to carry out tasks they felt contravened their legal right to make a conscientious objection. We then consider professional codes, UK legislation and church legislation. While the former are given strong weighting the latter was been ignored in this case, although cases in other European countries have been prevented from escalating to such a high level by the intervention of prominent church figures. The paper concludes by stating that the question put to the courts remains as yet unanswered but offers some recommendations for future policy making and research.

Nurses' and Midwives' Views on Approaches to Hymen Examination

Premarital sexual relations are unacceptable for women within Turkish society's understanding and perception of honour. If there is any suspicion about virginity, young girls are forced to undergo hymen examination against their will, which frequently results in attemped suicide. The most frequent cause of suicide in young Turkish girls is hymen examination. Nurses and midwives are always involve in this procedure. The purpose of this study was to determine the views of and approaches to hymen examination by nurses and midwives. Of those who participated in this study, 80.2% had been present during a hymen examination, 40.4% indicated that virginity had a special significance in the society owing to social pressures, and 37.5% indicated that they agreed with the view that the idea of virginity puts restraints on a woman's sexual life, whereas sexual activity is a physiological need. They also indicated their opposition to hymen examination imposed without the individual's consent. They agreed that stopping this practice depended more on the social structural changes required than on legal measures.

The Practice Setting: site of ethical conflict for some mothers and midwives

Practitioners’ ethical orientation and responses vary between practice settings. Yet, currently, the ethics for midwifery practice that is explicit in the literature and which provides the ideals of socialization into practice, is that of bio(medical)ethics. Traditional bioethics, developed because of World War II atrocities and increased scientific research, is based on moral philosophy, normative theory, abstract universal principles and objective problem solving, all of which focus on right and wrong ‘action’ for resolving dilemmas. They exclude context and relationship.

Personal narratives of mothers and midwives contest the appropriateness of these accepted values and systems for childbirth because they induce conflict between work-place/service provider ethics and personal/professional midwifery ethics. In contrast to the disembedded and disembodied approach of biomedical ethics, an ethically adequate response in midwifery practice resonates more with the ethics of intimates, such as feminist virtue ethics.

Are Nursing Codes of Practice Ethical?

This article provides a theoretical critique from a particular ‘ideal type’ ethical perspective of professional codes in general and the United Kingdom Central Council for Nursing, Midwifery and Health Visiting (UKCC) Code of professional conduct (reprinted on pp. 77-78) in particular.

Having outlined a specific ‘ideal type’ of what ethically informed and aware practice may be, the article examines the extent to which professional codes may be likely to elicit and engender such practice. Because of their terminological inexactitudes and confusions, their arbitrary values and principles, their lack of helpful ethical guidance, and their exclusion of ordinary moral experience, a number of contemporary professional codes in health and social care can be arraigned as ethically inadequate. The UKCC Code of professional conduct embodies many of these flaws, and others besides. Some of its weaknesses in this respect are anatomized before some tentative suggestions are offered for the reform of codes and the engendering of greater ethical awareness among professionals in the light of greater public ethical concerns and values.

New code is a victory for consensus in the profession, says regulator

The Nursing and Midwifery Council's code of conduct is at the heart of every nurse's practice, setting out standards of conduct, performance and ethics for the profession.

Nurse‐Midwife and Scientist: Stuck in the Middle?

The nurse-midwife and scientist share similar ethos (fundamental attitudes that guide action); yet, in their respective professional roles, ethos can translate into actions that appear discordant. Discord can lead to resolution, when examined through the primary principles of ethical conduct: autonomy, beneficence, nonmalfeasance, and justice.

Ethics of justice and ethics of care

Adolescent's sexuality and related reproductive health and rights problems are sensitive issues in Vietnam. Globalisation has had an impact on the lifestyles of young people, and rising numbers of abortion and STI/HIV risks among youth are posing major health concerns in the country. These problems need to be addressed. Midwives belong to a key category of health personnel in Vietnam, whose task it is to promote adolescents' sexual and reproductive health and prevent reproductive ill health. It is important to understand future midwives' perceptions and attitudes in order to improve their education and training programmes.

AIM

The aim of this study was to investigate Vietnamese midwifery students' values and attitudes towards adolescent sexuality, abortion and contraception and their views on professional preparation.

METHODS

A quantitative survey including 235 midwifery students from four different secondary medical colleges in northern Vietnam was carried out in 2003. A qualitative study addressing similar questions was performed and 18 midwifery students were individually interviewed.

FINDINGS

Findings revealed a general disapproval of adolescent pre-marital sexual relations and abortion-'an ethics of justice'-but also an empathic attitude and willingness to support young women, who bear the consequences of unwanted pregnancies and social condemnation-'an ethics of care'. Gender-based imbalance in sexual relationships, limited knowledge about reproductive health issues among youth, and negative societal attitudes were concerns expressed by the students. The students saw their future tasks mainly related to childbearing and less to other reproductive health issues, such as abortion and prevention of STI/HIV.

CONCLUSION

Midwifery education in Vietnam should encourage value-reflective thinking around gender inequality and ethical dilemmas, in order to prepare midwives to address adolescents' reproductive health needs.

Standards for education and training for interagency working in child protection in the UK: implications for nurses, midwives and health visitors

This article presents a discussion of key issues for the education of nurses, midwives and health visitors following the completion of a Department of Health funded project, managed by the General Social Care Council and conducted jointly by two research centres; Salford Centre for Social Work Research and Salford Centre for Nursing, Midwifery and Collaborative Research. The work was initiated in response to Lord Laming's report on the circumstances leading to the death of Victoria Climbié. The project was conducted in relation to specified professions and occupational groups: doctors; health visitors; midwives; nurses; police; teachers, and social workers. It was undertaken in two stages. The first stage mapped existing material about standards in relation to education and training for interagency working. The second stage engaged in an extensive consultation exercise through which a model and a set of proposed standards for interagency education and training for interagency work were developed. The former is detailed fully in this report, while nine examples of standards are presented. The project final report was presented seven months after commencement.

Dilemmas in fetal medicine: premature application of technology or responding to women's choice?

It is argued that innovative health technologies (IHTs) may be changing the roles of both patients and health practitioners, and raising new issues, including ethical, legal and social dilemmas. This paper focuses on the innovative area of fetal medicine. All fetal treatment necessitates accessing the fetus through the pregnant woman's body, and non-surgical treatments have long been a part of pregnancy care. However, recent developments in this area, including the increasing routinisation of sophisticated antenatal ultrasound screening and the introduction of treatments including fetal surgery, may mark a shift in this specialty. The paper explores such shifts from the perspectives of medical and midwifery practitioners working in two Fetal Medicine Units. It examines the apparent effects of the orientation of fetal medicine on prevalent conceptualisations of the maternal-fetal relationship, and some of the consequences of this. It is argued that new forms of uncertainty, including complex risk and diagnostic information, and uncertain prognostic predictions set within the rhetoric of non-directive counselling and women's choice, are leading to unprecedented ethical dilemmas within this area. More widespread debate about such potential dilemmas needs to take place before, rather than following their introduction.

Midwives' attitudes to and knowledge about a newly introduced foetal screening method

A number of screening procedures are offered by midwives during pregnancy and the number is increasing rapidly. The measurement of nuchal translucency is a fairly new ultrasound method for antenatal screening, primarily for Down syndrome. The results give a better risk calculation than maternal age alone and can mean a decrease in the number of invasive procedures needed to identify this syndrome prenatally. The aim of this study was to gain insight into the midwives' point of view concerning the introduction of the method in two different hospitals. In one hospital it had been introduced as part of a research project while in the other it had been integrated as an offer in the antenatal care programme. A questionnaire was sent to the 80 midwives working in the antenatal clinics serving these two hospitals. A total of 79% of the questionnaires were answered. The results indicate that in both districts, the similarities are greater than the differences with regard to the midwives' education, knowledge and their own opinions of their ability to inform pregnant women about the method. Although most of the respondents were positive to it, a number of midwives felt that, in general, information about foetal diagnosis was a difficult part of their work, mentioning both ethical and practical aspects. This highlights the need for continuing education, standardized policy and an ongoing ethical debate.

The perceived problem solving ability and values of student nurses and midwives

Problem solving is defined as a response given in an important and difficult situation, where critical thinking is required for a solution. Problem solving skills determine a person's ability to relate productively. This research was to determine the perceived problem solving ability and values of student nurses and midwives. It was planned as a descriptive research project in the University of Kocaeli's, Higher School of Health (Nursing and Midwifery School) in order to find out how students perceive their own problem solving skills, and to examine the relationship between problem solving skills and personal values. The data were collected from 218 students by using a questionnaire to determine the characteristics of the students and the "Problem Solving Inventory" (developed by Heppner and Petersen [Journal of Counseling Psychology 29 (1) (1982) 66]) whose reliability and validity for our country had been tested by Sahin et al. (1993) The scores of the subjects were evaluated and analyzed. Students who describe themselves in accordance with the values of truth (14.2%) and human dignity (19.3%) were also found to evaluate themselves successful in problem solving. Students who expressed that they act systematically (44.5%) and decisively (74.3%) in problem solving were also found to evaluate themselves as successful (47.8%) in problem solving. The results of our study have shown that education in professional ethics should provide the development of professional values (especially of truth and human dignity). Concerning value-laden issues education should help students to reach the desired levels of problem solving skills by allowing them to acquire abilities such as self awareness and being inquisitive.

Conducting international research in midwifery: a workshop held at the ICM Congress, Vienna, April 2002

A workshop on international research in midwifery was held at the triennial International Confederation of Midwives (ICM) Congress in Vienna, April 2002. Thirty-five participants from 12 countries took part. The participants themselves defined the agenda, and subsequent discussion addressed the following issues: international research relationships and collaboration; ethical conduct in international research in midwifery; the role of the ICM in international research; and identifying topics for an international midwifery research agenda. Recommendations arising from this workshop were: that guidelines and a code of ethics for the conduct of international research in midwifery be developed; that the ICM and national midwifery organisations continue to actively support research, and further develop that support; that the ICM support education and capacity building for research at basic and continuing education levels; and that the priorities identified for collaborative international studies be updated on a regular basis.