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Developments of perinatal technology and ethical decision-making during pregnancy and birth: the obstetricians' perspective

Objective

OBJECTIVES

To explore obstetricians' views, attitudes and self-reported practices regarding ethical decision-making in perinatal care, with special reference to:

- situations of conflict of rights between mother and fetus
- therapeutical decisions at birth for extremely premature or malformed newborns;
- communication with the parents-to-be and the neonatologists in comparison with the views and practices reported by the neonatologists within the framework of a previous European concerted action (EURONIC).

While ethical issues in perinatal care have been widely discussed in the literature from a theorethical point of view, the empirical evidence about physicians' actual opinions and behaviours is scarce and fragmented. By collecting comparable information across different European countries and cultures, this study will provide a clearer understanding of the decision-making patterns, and sounder knowledge upon which both individual choices and policy setting might be based.

The overall objective of this project is to explore the obstetricians' views, attitudes and self-reported practices regarding ethical decision-making in perinatal care, with special reference to:
1. situations of conflict of rights between mother and fetus;
2. selective non treatment decisions at birth for extremely premature or malformed newborns;
3. communication with the parents-to-be and the neonatologists in relation to the legal and ethical background of the participating countries and in comparison with the views and practices reported by the neonatologists within the framework of a previous European C.A. project (EURONIC).

To meet this objective, it will be necessary to describe:
a. The obstetrics departments where the ethical decision-making process takes place: structure, organization, workload and policies (sub-project no.1);
b. The obstetricians' views, attitudes and self-reported practices. This will be accomplished through:
b. a qualitative study (sub-project no.2) performed through in-depth, semi-structured personal interviews on a small sample of obstetricians (only in Italy and France);
b.2 a quantitative study (sub-project no. 3), carried out in all participating country by means of an anonymous, self-administered questionnaire which will be distributed to all the obstetricians working in the Departments recruited within sub-project no.1;
c. The relevant legislation and official bodies recommendations (sub-project no. 4).

The major strengths of this project lie in:
1. its multidisciplinary approach, as documented by the composition of the study group which brings together professionals with different backgrounds and expertise;
2. the nationwide random sampling of the obstetrics departments to be recruited which guarantees the unbiased sample selection and the validity of results;
3. the link with EURONIC, which will allow the utilization of an already established network of randomly selected hospitals, and the comparison between the findings from the obstetricians' and neonatologists' survey, to yield a complete picture of the ethical decision-making path in perinatal care across Europe.

Coordinator

Istituto per l'Infanzia 'Burlo Garofolo'
Address
Via Dell'istria
34100 Trieste
Italy