Sympathetic responsibility in ethically difficult situations

Abstract

"There is much going on, much dynamic and many points of view". Co-operation and genuine communication with the midwives and other professionals are important issues while handling an ethically difficult situation to reach the best outcome for mother and infant. 2 Sympathetic Responsibility in Ethically Difficult SituationsBackground: Ethical issues arise in many obstetric situations and demand constant consideration by obstetricians. The aim of this study was to highlight the meaning of being in an ethically difficult situation as narrated by obstetricians.Method: A descriptive design with a qualitative approach using a hermeneutic phenomenological method for analysis. Interviews were performed with fourteen obstetricians working in a Swedish hospital setting.Results: The overriding theme was Sympathetic responsibility in decisions of critical importance for the mother and her infant. Five related themes; To proceed with a moral reasoning that leads to the choice of a possible solution; To balance one's own medical knowledge and moral insight with the needs and requests of the parents; To be aware of one's medical and moral responsibility in relation to the decision made; To experience the ability to take action and to make and carry out difficult and important decisions relating to the health of the mother and infant; and To reflect on a given situation in a manner leading to a rational acceptance of one's own conduct.Conclusions: Sympathetic responsibility is the structure of the meaning of the obstetricians´ lived experience, which means that the obstetricians with the help of their medical knowledge and their desire to support the mothers autonomy, do what is best for the mother and her infant. Implications include that an exchange of ethical thoughts and moral reasoning should lead to a higher degree of mutual understanding between colleagues and between the different professionals. Co-operation is important to achieve the best outcome for the mother and her infant.

Attitudes of Swedish midwives towards management of extremely preterm labour and birth

“…Although, medical decision-making is the role of the obstetricians and even if they involve the parents to take part they cannot allow the parents to decide alone in decisive situations, it is their medical responsibility to make the final decision and when doing so lessen the feelings of guilt in the parents (Danerek et al, 2005). The obstetricians have an ongoing dialogue with the midwife involved in the current case and with the parents, the purpose of which is to achieve a decision acceptable for the all parties involved (ibid).…”

“…Information, in cases of threatened preterm birth, should be given to the parents by the professionals so that the parents are able to make an informed choice (Sharp, 1998;Danerek et al, 2005;Danerek & Dykes, 2008;Kavanaugh et al, 2005;Chan et al, 2006). The obstetrician and the midwife have the obligation to inform the parents about the prognosis and treatment based on scientifically based information and proven experience.…”

“…(Danerek & Dykes, 2001). Decision-making often follows clinical guidelines, but in the case of preterm labour and birth these are not always sufficient and decisions are then made on an individual basis (Garel et al, 2002;Garel et al, 2004;Danerek et al, 2005;Pignotti & Donzelli, 2008).…”

“…Decision-making concerning very preterm and still more, extremely preterm labour and birth can place a strain on all those involved, which was noted in interviews with parents (Jackson et al, 2003;Danerek & Dykes, 2008) and obstetricians in Sweden (Danerek, Udén & Dykes, 2005). The majority of parents wish to be active in decision making on behalf of their infant (McHaffie Lyon and Hume, 2001;McHaffie, Laing, Parker, and McMillan, 2001;Danerek et al, 2005).…”

“…The majority of parents wish to be active in decision making on behalf of their infant (McHaffie Lyon and Hume, 2001;McHaffie, Laing, Parker, and McMillan, 2001;Danerek et al, 2005).…”