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  • Title: Ethics and reproductive health: a principled approach.
    Author: Macklin R.
    Journal: World Health Stat Q; 1996; 49(2):148-53. PubMed ID: 9050194.
    Abstract:
    Universal ethical principles can be used to analyse problems in reproductive health. The principle of beneficence obligates people to strive to bring about more beneficial consequences than harmful ones. The principle known as respect for persons presumes that all human beings have dignity and are worthy of respect. Showing equal respect for women as persons means recognizing their autonomy and treating them as capable decision-makers and full participants in medical decisions. A third leading concern of bioethics is justice, which requires a fair distribution of family planning methods, including access to safe abortion in cases of contraceptive failure. Individual physicians, governments, and health-related nongovernmental organizations have an ethical obligation to reduce the rate of maternal mortality in developing countries. Laws, policies, and practices must be changed if they result in consequences more harmful than helpful. While ethical principles cannot dictate solutions to problems that arise from a genuine lack of resources, they do indicate solutions to preventable problems. Such universal ethical principles include the principle of beneficence, which obligates people to attempt to produce more good than harm. Thus, physicians, family planning (FP) programs, and reproductive health services must make valid risk-benefit assessments using appropriate data and considering the cultural context. Balancing risks and benefits involves objective and subjective analyses that must take into account women's actual experiences and attitudes, not simply what a care-giver believes is best for women. Recognition that reproductive rights exist within the larger framework of human rights calls into play the universal ethical principle of "respect for persons" which involves the principle of individual freedom or liberty. This principle may be violated, for example, when women seeking postabortal medical care are treated punitively. Realization that no judge would force a parent to provide transplant material for a dying child clarifies why women's right to control their own bodies supersedes the rights of fetuses in abortion debates. A third bioethical concern, justice, calls for equitable access to reproductive health services and creates a moral obligation to ensure that women have information and means to obtain FP. No cultural or religious reasons can condone a practice, such as female genital mutilation, which violates these bioethical principles. History and tradition are unreliable moral guides.
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