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The Northwestern University Twin Study XV: Rationales for a Standard of Care in Compromised Twin Pregnancies

Published online by Cambridge University Press:  01 August 2014

J.P. Minogue*
Affiliation:
Department of Obstetrics and Gynecology, Prentice Women's Hospital and Maternity Center, Northwestern University Medical School, Chicago, Illinois, USA
R.K. Tamura
Affiliation:
Department of Obstetrics and Gynecology, Prentice Women's Hospital and Maternity Center, Northwestern University Medical School, Chicago, Illinois, USA
L.G. Keith
Affiliation:
Department of Obstetrics and Gynecology, Prentice Women's Hospital and Maternity Center, Northwestern University Medical School, Chicago, Illinois, USA
*
Department of Obstetrics and Gynecology, Northwestern University Medical School, 333 East Superior Street, Suite 461, Chicago IL 60611, USA

Abstract

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Current antenatal technologies have improved the obstetrician's ability to assess fetal well-being as well as to diagnose fetal compromise. These technologies have given rise to very difficult ethical issues in the management of compromised twin pregnancies: for example, a choice must be made between putting a healthy twin at risk due to preterm delivery for the sake of a compromised cotwin or of allowing the compromised twin to die in order to buy time for the healthy twin. Though each case is unique, good medical practice requires a standard of care by which consistent patient management can be proposed. In the pluralistic environment of Northwestern Memorial Hospital, our staff has favored a standard of care based on patient autonomy. This approach demands: 1) a practitioner who offers a thorough explanation of the diagnosis and possible treatment approaches; 2) time for the patient and her partner to assimilate this information and test treatment options against their personal value system; 3) a third, but disinterested, party to facilitate patient understanding and value clarification; 4) a practitioner either willing to support the patient's decisions or refer her to another practitioner who will.

Type
Research Article
Copyright
Copyright © The International Society for Twin Studies 1990

References

REFERENCES

1.Aristotle, (1962): Nicomachean Ethics (trans. Ostwald, M). Indianapolis: Bobbs-Merrill, pp 333.Google Scholar
2.Beauchamp, T, Childress, J (1979): Principles of Biomedical Ethics. New York: Oxford University Press, pp 5685.Google ScholarPubMed
3.Hippocrates (trans. Jones, WHS) (1923): The Loeb Classical Library, Vol 1. Cambridge: Harvard University Press, pp 164165.Google Scholar
4.Kant, I (1959): Foundations of the Metaphysics of Morals (trans Beck, LW). New York: Bobbs-Merrill, pp 39.Google Scholar
5.Mill, J (1871): Utilitarianism, 4th ed. London: Longsmans, Green, Reader, and Dyer, pp 831.Google Scholar
6.Minogue, J (1978): A Journey in Compassion. Unpublished thesis. Mundelein, IL: St. Mary's of the Lake University, pp 99100.Google Scholar
7.Munson, R (1983): Intervention and Reflection: Basic Issues in Medical Ethics, 2d ed. Belmont, California: Wadsworth Publishing Company, pp 2126.Google Scholar
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