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EDITORIAL

Tomorrow’s Ethics for Today’s Practice

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he new millennium, with its ever-increasing advancenformation and biomedical technologies, can be a streime for women, their families, and those who provealth and illness care services. Public and private diions are questioning the very foundations of what it mo be a moral agent or ethical person and how to promoral or ethical society where all have a positive rightredetermined basic level of health and illness servhould our society continue its support of the ethoncept of autonomy and individual self-determinatioights, without due consideration and balance of whaest for society as a whole?1 What about those individuand families who are poor, disenfranchised or marginalnd required to fend for themselves when it comes to hervices that are a market commodity rather than a sgood” in the United States? Midwives and other womeealth care practitioners know that our most vulneropulations are women and children and that the Untates is the only industrialized country that doesuarantee access to prenatal care and other childbeervices—an embarrassment for those committed tong pregnancy and birth safer for all women and tewborns.2

This home study issue focuses on everyday etoncerns surrounding the health of women and serrovided for women. The focus of this issue is contin

earning in ethics for the experienced clinician. Our socs riding the crest of a new wave of technologies, includhe human genome project, which is raising more queshan answers when it comes to understanding howuman body works. Everyday experiences of midwivesther health professionals working with women through

heir lives are addressed. Selected authors provide infoion on the need to know how to think through and procomplex issues and how to make decisions that affecery core values and rights of both women seeking heare and the professionals who serve them. We caonger ignore the need to be competent in moral reasond ethical decision making, because ethical practicessential core of being a professional.3

Professional health care providers caring for womeed to understand both the foundations of ethics (thase) and the application of this understanding in dractice (applied ethics). One of the goals of this htudy on ethics is to encourage midwives and other hrofessionals to read, explore, discuss, and apply anderstanding of what it takes to be a professional to

nd tomorrow. t

ournal of Midwifery & Women’s Health • www.jmwh.org2004 by the American College of Nurse-Midwives

ssued by Elsevier Inc.

The series of articles in this issue begins with founional content: a human rights framework in midwiferactice is described in the first article by Joyce ThompNM, DrPH, also guest editor of the series. Rosemann, CNM, JD, PhD, addresses the important interfac

aw and ethics in reproductive health, and Anne ThompM, RN, MTD, provides a vital international perspectn the teaching of ethics. Judith Fullerton, CNM, PhD,eorgia Sadler, PhD, MBA, focus on research ethics

he ethical implications of including women in clinicrials.

Following this overview of ethics theory as appliedealth care of women, the issue continues with a focu

he application of ethics in practice. Because communion and values clarification are essential components ohow” to practice ethically, there is a large sectionontent on counseling—the what, how, why, and wheharing information with clients in a variety of situationsell as the impact of that information sharing on womnd their families. Margaret Commerford-Freda, EdD,HES, lays the groundwork on counseling techniquesarcia Van Riper, RN, PhD, and Wendy McKinnon, MGC, address ethical concerns present in genetic tend counseling for breast and ovarian cancer susceptilena Gates, MD, focuses on risks and counseling relatrenatal testing, and Lisa Mitchell, PhD, describes Cian women’s experiences with unexpected ultrasondings of fetal abnormalities or demise. This sectionthical concerns within reproductive health is complete

he article by Janet Singer, CNM, MSN, which addrene of the more emotional and difficult ethical issues ineld: options counseling for women with unintended prancies. As the reader will realize, addressing ethicaily practice is very complex and often difficult.Prenatal and labor care are among the most b

ctivities of midwives and are certainly areas requithical decision making on a daily basis. The final secf this issue provides practical advice on how to analyzethical dimensions of one’s practice using a prenatalxample analyzed by Deborah Narrigan, CNM, MSN,n analysis of an ethical approach to the discussion anf pain relief techniques during labor by Nancy LowNM, PhD. The final article is an invited commentaryatricia Benner, RN, PhD, on the dangers of geneticishat may be seen as the frontier of tomorrow’s ethicsA brief disclaimer is indicated when it comes to prod

ng this home study on ethics. When it comes to selec

he relevant content to be included in a limited publication,

1731526-9523/04/$30.00• doi:10.1016/j.jmwh.2004.03.002

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ne is placed in a difficult position. There simply is notnough room to include everything needed to understandoth the theoretical foundations (the “why” of ethics) asell as the application (the “how” ) of moral reasoning and

thical decision making in clinical practice. The obviousaps not covered in this issue of JMWH include ethicsheory, values development and clarification, professionalodes of moral behavior or conduct, and the ethics ofealth/public policy. The reader with limited knowledge ofhese is referred to the Resources for Clinicians column andhe printed version of the International Confederation of

idwives’ International Code of Ethics for Midwives1999 revision) and the American Nurses Association Codeor Nurses 2003. As this issue is going to press, themerican College of Nurse-Midwives (ACNM) Code ofthics for Midwives 1990 is under revision, consideringome of the new ethical concerns raised by global attentiono human rights, safer pregnancy and birth, and personalccountability in counseling women with ever-emergingenetic information. Everyday ethical concerns raised inidwifery (women’s health) practice span the entire range

f health care ethics. This includes one’s decision in howuch time to spend with a given woman/family in view of

ther responsibilities, how and what information to share toromote informed decision making, and how to resolvene’s personal value conflicts when a woman asks fornformation or a service you cannot support. Maintainingonfidentiality; understanding the rights, duties, and obli-ations of the professional; acknowledging client self-etermination and responsibilities; conducting informed

onsent; and recognizing the interface of law and ethics in n

74

ealth care are but a few of the ethical issues that arise inhe daily practice of midwives.

I close with a request that the reader “ listen” to the voicesf women and families—their poignant stories—includedn these articles, that you “hear” their concerns and theoncerns of the midwives caring for and with them, andbove all, that you “act” responsibly/ethically, followinghe moral code of the profession and principles of account-bility that result from being a moral agent—a professionalidwife—who knows, understands, and practices in an

thical manner at all times! These are exciting times foromen and their health services, and it is hoped that this

thics home study will peak your interest in learning morebout tomorrow’s ethics for today’s midwifery practice.

Joyce Beebe Thompson, CNM, DrPH,FAAN, FACNM

Guest EditorLacey Professor of Community Health Nursing

Director, Board of Management, InternationalConfederation of Midwives

Past ACNM President

EFERENCES

1. Patel K, Rushefsky M. Health care policy in an age of newechnologies. New York (NY): M.E. Sharpe, 2002:3–27.

2. Partnership for Safe Motherhood & Newborn Health 2004 [In-ernet]. [Cited March 2, 2004]. Available from: www.safemotherhood.rg.

3. Thompson J, Thompson H. Bioethical decision making for

urses. Norwalk (CT): Appleton-Century-Crofts, 1985:13.

Volume 49, No. 3, May/June 2004