Ethical Problems in Obstetrics and Gynaecology

Ethical Problems in Obstetrics and Gynaecology

European Journal of Obstetrics & Gynecology and Reproductive Biology 98 (2001) 260±261 Book reviews From Subsistence to Exchange and Other Essays. Wi...

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European Journal of Obstetrics & Gynecology and Reproductive Biology 98 (2001) 260±261

Book reviews From Subsistence to Exchange and Other Essays. With an Introduction by Amartya Sen Peter Bauer, Princeton University Press, Princeton, NJ, USA, 2000 ``Development economics'', the study of the process whereby countries transform themselves from primitive subsistence into modern exchange economies is, with one exception, of little direct relevance to obstetrician gynaecologists. The exception is the effect of population on this process, and the appropriate role of government sponsored population control programmes. Anyone advocating the implementation of such programmes in less developed countries should read the chapter ``Population explosion: disaster or blessing'', in this restrained and cautious book by Lord Bauer, Professor Emeritus at the London School of Economics. He effectively demolishes the popular justi®cation for foreign aid for contraception, by nailing three widespread myths. Firstly, when population alters, income per head does not adequately measure economic well-being, for the simple reason that the birth of wanted children appears to lower this index, while the death of children appears to raise it. Secondly, economic progress is not critically dependent on the supply of land or capital per head. It depends on cultural attitudes and political institutions, and is just as likely to be retarded by low population. Finally, the people of less developed countries are neither ignorant of the way to control fertility, unable to do so if they wish, nor acting irrationally under the sway of uncontrollable sexual urges. Like the rest of us they generally have children when they want them. A few have more than they wish and many have less. Since even voluntary programmes designed to increase choice, easily become coercive in the highly politicised countries typical of the developing world, we should avoid them. The remainder of the book is interesting but less directly relevant to obstetrician/gynaecologists. Bauer shows how foreign aid, buttressed by western guilt and elementary economic errors, often harms development. Only trade with the much-maligned western free market reliably provides capital where it will best promote development, the consumer goods that give an incentive to save, and teaches people the habits and customs of investment and trading. Bauer himself showed many years ago in his studies of the rubber market in West Africa, how little of such trading is recorded in of®cial statistics. I particularly liked the chapter ``Ecclesiastical economics: envy legitimised'' dissecting the economic illiteracy of many Papal pronouncements. Readers

unfamiliar with Bauer may imagine from reading the above that this is an extreme libertarian tract. It is not. As the Nobel prize-winner Amartya Sen says in his introduction, Bauer's views are now commonplace among development economists. However, as the recent anti-trade protests in Seattle and Prague have shown they have a long way to go to achieve popular acceptance. Until they do many inhabitants of poor countries will continue to have their prospects blighted by well meaning but misguided attempts by western agencies to help. People in positions of in¯uence would do well to read this small collection of essays. J.G. Thornton Centre for Reproduction Growth and Development University of Leeds, 34 Hyde Terrace Leeds L92 9LN, UK Tel.: ‡44-113-392-6370; fax: ‡44-113-392-6452 E-mail address: [email protected] PII: S 0 3 0 1 - 2 1 1 5 ( 0 0 ) 0 0 5 5 2 - 2

Ethical Problems in Obstetrics and Gynaecology C. Sureau and F. Kohane Shenfield (Eds.), Clinical Obstetrics and Gynaecology; S. Arulkumaran (Editor-in-Chief), BaillieÁre, l Best Practice and Research, Vol. 13, No. 4, BaillieÁre Tindall, 24±28 Oval Road London, 1999 Harcourt Publishers Ltd., London NW1 7DX Ethical problems in obstetrics and gynaecology are not new. Hippocrates devoted almost his whole life to them. This culminated in the famous oath. This volume covers some new topics. In Part I, practical clinical problems are discussed: principles and examples (Friend, UK), new reproductive technologies (Jones Jr., USA), fetal medicine (Chervenak and McCullough, USA) and neonatal care (Wyatt, UK). The authors are not always in agreement. Chervenak ®nds viability of the fetus to be the point of change of interest, while Friend considers such an attitude with a more balanced view. Embryo research is considered legitimate by Jones. In some countries, however, this is legally forbidden. Friend considers the practitioner to be an advocate for the patient. Wyatt stresses more the responsibility of the patient but being a paediatrician, he is the advocate for the baby as well as for the family. The refusal of caesarean section or ``irresponsible behaviour'' of a future mother is loaded with the fact that the unborn had no legal rights.

0301-2115/01/$ ± see front matter # 2001 Elsevier Science Ireland Ltd. All rights reserved.

Book reviews

Part II covers medical practice and society: alternative regulatory perspectives of obstetrics and gynaecology (Le Bris and Luther, Belgium and UK), Eugenics (Missa, Belgium) and economics and justice (Milliez, France). Le Bris and Luther discuss the interplay of ethics, deontology (selfregulation) and law (state model). The birth of Louise Brown some 20 years ago gave also birth to an explosion of ethical debate. Now, more of medicine are regulated by law-abortion, organ transplantation, medical research, new reproductive technologies, genetics, euthanasia). Missa sets the tone with radical eugenics between the two world wars and the practice of the Nazis. State eugenics and eugenics as an individual choice have to be distinguished. Milliez remarks that the relationship between the economy and medical decisions in the ®eld of human reproduction are closely linked to political matters. In Part III, international aspects of ethical problems in obstetrics and gynaecology are discussed by Potts and Shouse (USA) and endocrine disruption cloning, ICSI, and pollution by Vandelac and Bacon (Canada). A general conclusion by the editors describes the role and responsibility for the practising


obstetrician gynaecologist. They stress the fundamental role of the medical profession acting between the patient, bureaucracy and the community at large. Medicine the ®rst profession to establish self-regulatory rules in the form of ``the Hippocratic oath''. We hope this will not be forgotten by those who want to change everything. This booklet contributes towards the needs of modern society and is recommended to all who have to guide dif®cult decisions in human reproduction. Tom K.A.B. Eskes Department of Obstetrics and Gynaecology University Hospital Nijmegen, P.O. Box 9101, 6500 Nijmegen, The Netherlands Tel.: ‡31-243614725; fax: ‡31-243541194. E-mail address: [email protected] Accepted 16 February 2001 PII: S 0 3 0 1 - 2 1 1 5 ( 0 1 ) 0 0 3 2 3 - 2