Gebeliğin Yönetimi ve Etik
Özet
Gebelik süreci hem anne hem de fetüsün sağlık durumunu ilgilendiren dinamik bir süreçtir. Bu dinamik sürecin doğası gereği çeşitli etik sorun ve ikilemlerle karşılaşmak mümkündür. Gebelik sürecinde; genetik tarama, prenatal tanıyı takiben gebeliğin sonlandırılması, ciddi malformasyonlu fetüslerin yönetimi, fetüsün iyilik hali için gerekli müdahaleler, beklenmeyen ani maternal ölüm, çoğul gebelikler ve gebelikte kanser gibi konular etik sorunların ve etik ikilemlerin sık karşılaşıldığı konuları oluşturmaktadır. Gebelik sürecinde karşılaşılabilecek etik sorunların; multidisipliner bir ekip yaklaşımı ile temel etik ilkeler çerçevesinde, mevcut durumun anne-fetüs ikilisi göz önünde bulundurularak, güncel kanıta dayalı bilgiler ışığında, bireyselleştirilmiş bir tedavi ve bakım anlayışıyla yönetilmesi önem taşımaktadır. Bu bölümde, gebelik sürecinde karşılaşılabilecek etik sorun oluşturan konular ve yönetiminde etik yaklaşım ele alınmıştır.
Referanslar
Kerridge I, Lowe M, Stewart C. Ethics and law for health professionals. 3rd ed. Sydney, Australia: The Federation Press; 2009.
Chervenak FA, McCullough LB, Brent RL. The Professional responsibility model of obstetrical ethics: Avoiding the perils of clashing rights. American Journal of Obstetrics & Gynecology. 2011; 205(4): 315.e1–e5. doi: 10.1016/j.ajog.2011.06.006
Than NG, Papp Z. Ethical issues in genetic counselling, Best Practice & Research Clinical Obstetrics & Gynaecology. 2017; 43: 32-49. doi: 10.1016/j.bpobgyn.2017.01.005.
Jones RJ. Genetic counseling and prevention of birth defects. Journal of the American Medical Association. 1982; 248(2): 221-224.
Munger KM, Gill CJ, Ormond KE, et al. The next exclusion debate: assessing technology, ethics, and intellectual disability after the Human Genome Project. Mental Retardation and Developmental Disabilities Research Reviews. 2007;13(2):121-128. doi: 10.1002/mrdd.20146
Milunsky A. Genetic disorders and the fetus: Diagnosis, prevention and treatment. Fifth ed. Baltimore: Johns Hopkins University Press; 2004.
Uhlmann WR, Schuette JL, Yashar BMA. Guide to genetic counseling. 2nd ed. Hoboken, New Jersey, USA: Wiley-Blackwell; 2009.
Atar S, Yalım NY. Kişisel nedenler ile yapılan invaziv olmayan prenatal test ve etik değerlendirme. Türkiye Biyoetik Dergisi. 2019; 6(1): 26-33.
Kurul E, Mecdi Kaydırak M. Genetic counseling in the prenatal and postnatal period: The role and responsıbılıty of the nurse. Journal of Health Profession Research. 2022;4(3): 193-201. doi:10.57224/jhpr.1092043
Berceanu C, Albu SE, BoȚ M, et al. Current principles and practice of ethics and law in perinatal medicine. Current Health Sciences Journal. 2014; 40(3): 162-69. doi: 10.12865/CHSJ.40.03.02
Samsioe G, Abreg A. Ethical issues in obstetrics. International journal of fertility and menopausal studies. 1996; 41(3): 284-287.
Şenocak Z. Ceninin hukuki durumu. Beksaç MS (ed) Doğum Hekimliği, Maternal-Fetal Tıpta Etik ve Yasal Boyut içinde. Ankara: Mebas Medikal Basın Yayın; 2004.s. 44-46.
Savulescu J. Is there a “right not to be born?”? Reproductive decision making, options and the right to information. Journal of Medical Ethics. 2002; 28(2) :65-67. doi: 10.1136/jme.28.2.65
Milliez J. Ethical aspects concerning termination of pregnancy following prenatal diagnosis. International Journal of Gynecology and Obstetrics. 2008; 102 (1): 97-98. doi: 10.1016/j.ijgo.2008.03.002
Ege E, Pasinlioğlu T. Doğum ve kadın sağlığı hemşireliğinde etik. Atatürk Üniversitesi Hemşirelik Yüksekokulu Dergisi. 2000; 3(1): 50-44.
Şen C, Yayla M. Fetus hakları ve korunması. Perinatoloji Dergisi. 2002; 10(2): 43-46.
Kadayıfçı O, Ürünsak İ. Üreme Sağlığı ve Etik. 6. Ulusal Üreme Sağlığı ve Aile Planlaması Kongre Kitabı; Ankara; 2009. s. 104-101.
FIGO Committee. Obstetrik ve Jinekolojide Etik Konular. (İsmail Dölen, Çev. Ed.). Ankara: TJOD; 2008.
Austin MT, Cole TR, McCullough LB, et al. Ethical challenges in invasive maternal-fetal intervention. Seminars in Pediatric Surgery. 2019; 28(4): 150819. doi: 10.1053/j.sempedsurg.2019.07.002
O'Connor, K. Ethics of Fetal Surgery. Embryo Project Encyclopedia. 2012. p. 11-20. http://embryo.asu.edu/handle/10776/8011.
Antiel RM. Ethical challenges in the new world of maternal–fetal surgery. Seminars in Perinatology. 2016; 40(4): 227-233. doi: 10.1053/j.semperi.2015.12.012
Casper MJ. The making of the unborn patient: A social anatomy of fetal surgery. New Brunswick: Rutgers University Press; 1998.
Dayı A. Feminist etik açısından cinsellik ve üreme: Fetüsün bireyliği ve kadının beden bütünlüğü. Fe Dergi. 2017; 9(1): 36-54. doi:10.1501/Fe0001_0000000176
Chervenak FA, McCullough LB. Ethics and Professionalism Guidelines for Obstetrics and Gynecology. London: FIGO; 2021.
Chervenak FA, McCullough LB. Ethical challenges in the management of multiple pregnancies: the professional responsibility model of perinatal ethics. Journal of perinatal medicine. 2013; 41(1): 61-64. doi: 10.1515/jpm-2012-0056
Şal H, Cömert EH, Ekici YS, et al. Çoğul gebeliklerde selektif fetoredüksiyonun olgu sunumu eşliğinde değerlendirilmesi. Turkish Journal of Reproductive Medicine and Surgery. 2018; 2(1): 26-29. doi: 10.24074/tjrms.2018-61870
Eyi EGY, Danışman N, Çağlar AT. Çoğul gebeliklerin indirgenmesi. Jinekoloji-Obstetrik ve Neonatoloji Tıp Dergisi. 2013; 10(39): 1619-1622.
Legendre CM, Moutel G, Drouin R, et al. Differences between selective termination of pregnancy and fetal reduction in multifetal pregnancies: a narrative review. Reproductive BioMedicine Online. 2013; 26(6): 542–554. doi: 10.1016/j.rbmo.2013.02.004
Malhotra A, Menahem S, Shekleton P, et al. Medical and ethical considerations in twin pregnancies discordant for serious cardiac disease. Journal of Perinatology. 2009; 29(10): 662–667. doi: 10.1038/jp.2009.88
Pennings G. Selective termination, fetal reduction and analogical reasoning. Reproductive BioMedicine Online. 2013; 26(6): 525-527. doi: 10.1016/j.rbmo.2013.02.016
Baxi LV, Walsh CA. Monoamniotic twins in contemporary practice: a single-center study of perinatal outcomes. Journal of Maternal-Fetal & Neonatal Medicine. 2010; 23(6): 506-510. doi:10.3109/14767050903214590
Simpson LL. Twin-twin transfusion syndrome. American Journal of Obstetrics and Gynecology. 2013; 208(1): 3-18. doi: 10.1016/j.ajog.2012.10.880
Gheorghe CP, Boring N, Mann L, et al. Neonatal outcomes and maternal characteristics in monochorionic diamniotic twin pregnancies: uncomplicated versus twin-to-twin transfusion syndrome survivors after fetoscopic laser surgery. Fetal Diagnosis and Therapy. 2020; 47(2): 165–170. doi: 10.1159/000500858
Skupski D, Chervenak FA, McCullough L. An ethically justified decision-making pathway for the management of pregnancies complicated by twin-to-twin transfusion syndrome. Fetal Diagnosis and Therapy. 2007; 22(5): 339-342. doi: 10.1159/000103292
McCullough L, Coverdale J, Chervenak F. Cancer and Pregnancy. McCullough L, Coverdale J, Chervenak F (ed.). In Professional Ethics in Obstetrics and Gynecology. Cambridge: Cambridge University Press; 2019.p. 171-176.
Cordeiro C, Gemignani M. Gynecologic malignancies in pregnancy: balancing fetal risks with oncologic safety. Obstetrical & Gynecological Survey. 2017; 72(3): 184-193. doi: 10.1097/OGX.0000000000000407
Pereg D, Koren G, Lishner M. Cancer in pregnancy: gaps, challenges and solutions. Cancer Treatment Reviews. 2008; 34(4): 302-312. doi: 10.1016/j.ctrv.2008.01.002
Kalampokas E, Vlahos N, Kalampokas T, et al. Common malignancies during pregnancy: A comprehensive review. Cancer Diagnosis & Prognosis. 2021; 1(3):103-109. doi: 10.21873/cdp.10015.
Shampain KL, Wasnik AP. Bioethical issues in imaging cancer in pregnancy. Abdominal Radiology. 2023; 48(5): 1816-1818. doi:10.1007/s00261-023-03855-8
Soo-Hoo S, Luesley D. Vulval and vaginal cancer in pregnancy. Best Practice & Research Clinical Obstetrics & Gynaecology. 2015; 33: 73-78. doi: 10.1016/j.bpobgyn.2015.10.006
Jha P, Pōder L, Glanc P, et al. Imaging cancer in pregnancy. Radiographics. 2022; 42(5): 1494-1513. doi: 10.1148/rg.220005
Fancher KM, Giannetti V, McLaughlin BT. Ethics of chemotherapy during pregnancy. American Journal of Health-System Pharmacy. 2019; 76(4): 242-246. doi:10.1093/ajhp/zxy041
Foster IR, Lasser J. Ebelik Uygulamalarında Profesyonel Etik (Nermin ERSOY, Ayla ERGİN, Müesser ÖZCAN, Çev. Ed.). Ankara: Nobel Akademik Yayıncılık; 2015.
Baumrucker SJ, Vogel WH, Stolick RM, et al. A mother in jeopardy: The ethics of pregnancy and chemotherapy. American Journal of Hospice and Palliative Medicine®. 2020; 37(1): 72-78. doi:10.1177/104990911984686
Chervenak FA, McCullough LB, Knapp RC, et al. A clinically comprehensive ethical framework for offering and recommending cancer treatment before and during pregnancy. Cancer. 2004; 100(2): 215–222. doi: 10.1002/cncr.11564
Linkeviciute A, Buonomo B, Fazio N, et al. Discussing motherhood when the oncological prognosis is dire: ethical considerations for physicians. ESMO Open. 2020; 5(6): e000956. doi: 10.1136/esmoopen-2020-000956.
Linkeviciute A, Canario R, Peccatori FA, et al. Guidelines for cancer treatment during pregnancy: Ethics-related content evolution and implications for clinicians. Cancers (Basel). 2022; 14(17): 4325. doi: 10.3390/cancers14174325
Referanslar
Kerridge I, Lowe M, Stewart C. Ethics and law for health professionals. 3rd ed. Sydney, Australia: The Federation Press; 2009.
Chervenak FA, McCullough LB, Brent RL. The Professional responsibility model of obstetrical ethics: Avoiding the perils of clashing rights. American Journal of Obstetrics & Gynecology. 2011; 205(4): 315.e1–e5. doi: 10.1016/j.ajog.2011.06.006
Than NG, Papp Z. Ethical issues in genetic counselling, Best Practice & Research Clinical Obstetrics & Gynaecology. 2017; 43: 32-49. doi: 10.1016/j.bpobgyn.2017.01.005.
Jones RJ. Genetic counseling and prevention of birth defects. Journal of the American Medical Association. 1982; 248(2): 221-224.
Munger KM, Gill CJ, Ormond KE, et al. The next exclusion debate: assessing technology, ethics, and intellectual disability after the Human Genome Project. Mental Retardation and Developmental Disabilities Research Reviews. 2007;13(2):121-128. doi: 10.1002/mrdd.20146
Milunsky A. Genetic disorders and the fetus: Diagnosis, prevention and treatment. Fifth ed. Baltimore: Johns Hopkins University Press; 2004.
Uhlmann WR, Schuette JL, Yashar BMA. Guide to genetic counseling. 2nd ed. Hoboken, New Jersey, USA: Wiley-Blackwell; 2009.
Atar S, Yalım NY. Kişisel nedenler ile yapılan invaziv olmayan prenatal test ve etik değerlendirme. Türkiye Biyoetik Dergisi. 2019; 6(1): 26-33.
Kurul E, Mecdi Kaydırak M. Genetic counseling in the prenatal and postnatal period: The role and responsıbılıty of the nurse. Journal of Health Profession Research. 2022;4(3): 193-201. doi:10.57224/jhpr.1092043
Berceanu C, Albu SE, BoȚ M, et al. Current principles and practice of ethics and law in perinatal medicine. Current Health Sciences Journal. 2014; 40(3): 162-69. doi: 10.12865/CHSJ.40.03.02
Samsioe G, Abreg A. Ethical issues in obstetrics. International journal of fertility and menopausal studies. 1996; 41(3): 284-287.
Şenocak Z. Ceninin hukuki durumu. Beksaç MS (ed) Doğum Hekimliği, Maternal-Fetal Tıpta Etik ve Yasal Boyut içinde. Ankara: Mebas Medikal Basın Yayın; 2004.s. 44-46.
Savulescu J. Is there a “right not to be born?”? Reproductive decision making, options and the right to information. Journal of Medical Ethics. 2002; 28(2) :65-67. doi: 10.1136/jme.28.2.65
Milliez J. Ethical aspects concerning termination of pregnancy following prenatal diagnosis. International Journal of Gynecology and Obstetrics. 2008; 102 (1): 97-98. doi: 10.1016/j.ijgo.2008.03.002
Ege E, Pasinlioğlu T. Doğum ve kadın sağlığı hemşireliğinde etik. Atatürk Üniversitesi Hemşirelik Yüksekokulu Dergisi. 2000; 3(1): 50-44.
Şen C, Yayla M. Fetus hakları ve korunması. Perinatoloji Dergisi. 2002; 10(2): 43-46.
Kadayıfçı O, Ürünsak İ. Üreme Sağlığı ve Etik. 6. Ulusal Üreme Sağlığı ve Aile Planlaması Kongre Kitabı; Ankara; 2009. s. 104-101.
FIGO Committee. Obstetrik ve Jinekolojide Etik Konular. (İsmail Dölen, Çev. Ed.). Ankara: TJOD; 2008.
Austin MT, Cole TR, McCullough LB, et al. Ethical challenges in invasive maternal-fetal intervention. Seminars in Pediatric Surgery. 2019; 28(4): 150819. doi: 10.1053/j.sempedsurg.2019.07.002
O'Connor, K. Ethics of Fetal Surgery. Embryo Project Encyclopedia. 2012. p. 11-20. http://embryo.asu.edu/handle/10776/8011.
Antiel RM. Ethical challenges in the new world of maternal–fetal surgery. Seminars in Perinatology. 2016; 40(4): 227-233. doi: 10.1053/j.semperi.2015.12.012
Casper MJ. The making of the unborn patient: A social anatomy of fetal surgery. New Brunswick: Rutgers University Press; 1998.
Dayı A. Feminist etik açısından cinsellik ve üreme: Fetüsün bireyliği ve kadının beden bütünlüğü. Fe Dergi. 2017; 9(1): 36-54. doi:10.1501/Fe0001_0000000176
Chervenak FA, McCullough LB. Ethics and Professionalism Guidelines for Obstetrics and Gynecology. London: FIGO; 2021.
Chervenak FA, McCullough LB. Ethical challenges in the management of multiple pregnancies: the professional responsibility model of perinatal ethics. Journal of perinatal medicine. 2013; 41(1): 61-64. doi: 10.1515/jpm-2012-0056
Şal H, Cömert EH, Ekici YS, et al. Çoğul gebeliklerde selektif fetoredüksiyonun olgu sunumu eşliğinde değerlendirilmesi. Turkish Journal of Reproductive Medicine and Surgery. 2018; 2(1): 26-29. doi: 10.24074/tjrms.2018-61870
Eyi EGY, Danışman N, Çağlar AT. Çoğul gebeliklerin indirgenmesi. Jinekoloji-Obstetrik ve Neonatoloji Tıp Dergisi. 2013; 10(39): 1619-1622.
Legendre CM, Moutel G, Drouin R, et al. Differences between selective termination of pregnancy and fetal reduction in multifetal pregnancies: a narrative review. Reproductive BioMedicine Online. 2013; 26(6): 542–554. doi: 10.1016/j.rbmo.2013.02.004
Malhotra A, Menahem S, Shekleton P, et al. Medical and ethical considerations in twin pregnancies discordant for serious cardiac disease. Journal of Perinatology. 2009; 29(10): 662–667. doi: 10.1038/jp.2009.88
Pennings G. Selective termination, fetal reduction and analogical reasoning. Reproductive BioMedicine Online. 2013; 26(6): 525-527. doi: 10.1016/j.rbmo.2013.02.016
Baxi LV, Walsh CA. Monoamniotic twins in contemporary practice: a single-center study of perinatal outcomes. Journal of Maternal-Fetal & Neonatal Medicine. 2010; 23(6): 506-510. doi:10.3109/14767050903214590
Simpson LL. Twin-twin transfusion syndrome. American Journal of Obstetrics and Gynecology. 2013; 208(1): 3-18. doi: 10.1016/j.ajog.2012.10.880
Gheorghe CP, Boring N, Mann L, et al. Neonatal outcomes and maternal characteristics in monochorionic diamniotic twin pregnancies: uncomplicated versus twin-to-twin transfusion syndrome survivors after fetoscopic laser surgery. Fetal Diagnosis and Therapy. 2020; 47(2): 165–170. doi: 10.1159/000500858
Skupski D, Chervenak FA, McCullough L. An ethically justified decision-making pathway for the management of pregnancies complicated by twin-to-twin transfusion syndrome. Fetal Diagnosis and Therapy. 2007; 22(5): 339-342. doi: 10.1159/000103292
McCullough L, Coverdale J, Chervenak F. Cancer and Pregnancy. McCullough L, Coverdale J, Chervenak F (ed.). In Professional Ethics in Obstetrics and Gynecology. Cambridge: Cambridge University Press; 2019.p. 171-176.
Cordeiro C, Gemignani M. Gynecologic malignancies in pregnancy: balancing fetal risks with oncologic safety. Obstetrical & Gynecological Survey. 2017; 72(3): 184-193. doi: 10.1097/OGX.0000000000000407
Pereg D, Koren G, Lishner M. Cancer in pregnancy: gaps, challenges and solutions. Cancer Treatment Reviews. 2008; 34(4): 302-312. doi: 10.1016/j.ctrv.2008.01.002
Kalampokas E, Vlahos N, Kalampokas T, et al. Common malignancies during pregnancy: A comprehensive review. Cancer Diagnosis & Prognosis. 2021; 1(3):103-109. doi: 10.21873/cdp.10015.
Shampain KL, Wasnik AP. Bioethical issues in imaging cancer in pregnancy. Abdominal Radiology. 2023; 48(5): 1816-1818. doi:10.1007/s00261-023-03855-8
Soo-Hoo S, Luesley D. Vulval and vaginal cancer in pregnancy. Best Practice & Research Clinical Obstetrics & Gynaecology. 2015; 33: 73-78. doi: 10.1016/j.bpobgyn.2015.10.006
Jha P, Pōder L, Glanc P, et al. Imaging cancer in pregnancy. Radiographics. 2022; 42(5): 1494-1513. doi: 10.1148/rg.220005
Fancher KM, Giannetti V, McLaughlin BT. Ethics of chemotherapy during pregnancy. American Journal of Health-System Pharmacy. 2019; 76(4): 242-246. doi:10.1093/ajhp/zxy041
Foster IR, Lasser J. Ebelik Uygulamalarında Profesyonel Etik (Nermin ERSOY, Ayla ERGİN, Müesser ÖZCAN, Çev. Ed.). Ankara: Nobel Akademik Yayıncılık; 2015.
Baumrucker SJ, Vogel WH, Stolick RM, et al. A mother in jeopardy: The ethics of pregnancy and chemotherapy. American Journal of Hospice and Palliative Medicine®. 2020; 37(1): 72-78. doi:10.1177/104990911984686
Chervenak FA, McCullough LB, Knapp RC, et al. A clinically comprehensive ethical framework for offering and recommending cancer treatment before and during pregnancy. Cancer. 2004; 100(2): 215–222. doi: 10.1002/cncr.11564
Linkeviciute A, Buonomo B, Fazio N, et al. Discussing motherhood when the oncological prognosis is dire: ethical considerations for physicians. ESMO Open. 2020; 5(6): e000956. doi: 10.1136/esmoopen-2020-000956.
Linkeviciute A, Canario R, Peccatori FA, et al. Guidelines for cancer treatment during pregnancy: Ethics-related content evolution and implications for clinicians. Cancers (Basel). 2022; 14(17): 4325. doi: 10.3390/cancers14174325
