Professional Responsibility

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Frank A. Chervenak - One of the best experts on this subject based on the ideXlab platform.

  • the Professional Responsibility model of ethics in obstetrics and gynecology
    2018
    Co-Authors: Frank A. Chervenak, Laurence B Mccullough
    Abstract:

    The Professional Responsibility model of ethics in obstetrics and gynecology should guide decision-making and behavior in clinical practice, research, and education. The model is based on the ethical concept of medicine as a profession, introduced into the histories of medicine and medical ethics by the Scottish physician-ethicist, John Gregory (1724–1773), and the English physician-ethicist, Thomas Percival (1740–1804). They showed that, to be a Professional in the ethically significant sense of the word, physicians should commit themselves to scientific and clinical excellence and to the protection of the patient’s health-related interest, keeping self-interest systematically secondary. To fulfill these commitments, physicians should cultivate the Professional virtues of integrity, compassion, and self-sacrifice and conform clinical practice to the ethical principles of beneficence and self-sacrifice. The Professional Responsibility model uses these ethical concepts to create an account of the obstetrician-gynecologist’s ethical obligations to pregnant, fetal, and neonatal patients. The implications of virtue-based, beneficence-based, and autonomy-based obligations to patients must be all considered to reach deliberative judgments about Professionally responsible patient care, research, and education.

  • ethics and Professional Responsibility essential dimensions of planned home birth
    Seminars in Perinatology, 2016
    Co-Authors: Laurence B Mccullough, Robert L Brent, Amos Grunebaum, Birgit Arabin, Malcolm I Levene, Frank A. Chervenak
    Abstract:

    Abstract Planned home birth is a paradigmatic case study of the importance of ethics and Professionalism in contemporary perinatology. In this article we provide a summary of recent analyses of the Centers for Disease Control database on attendants and birth outcomes in the United States. This summary documents the increased risks of neonatal mortality and morbidity of planned home birth as well as bias in Apgar scoring. We then describe the Professional Responsibility model of obstetric ethics, which is based on the Professional medical ethics of two major figures in the history of medical ethics, Drs. John Gregory of Scotland and Thomas Percival of England. This model emphasizes the identification and careful balancing of the perinatologist’s ethical obligations to pregnant, fetal, and neonatal patients. This model stands in sharp contrast to one-dimensional maternal-rights-based reductionist model of obstetric ethics, which is based solely on the pregnant woman’s rights. We then identify the implications of the Professional Responsibility model for the perinatologist’s role in directive counseling of women who express an interest in or ask about planned home birth. Perinatologists should explain the evidence of the increased, preventable perinatal risks of planned home birth, recommend against it, and recommend planned hospital birth. Perinatologists have the Professional Responsibility to create and sustain a strong culture of safety committed to a home-birth-like experience in the hospital. By routinely fulfilling these Professional responsibilities perinatologists can help to prevent the documented, increased risks planned home birth.

  • the Professional Responsibility model of obstetric ethics and caesarean delivery
    Best Practice & Research in Clinical Obstetrics & Gynaecology, 2013
    Co-Authors: Frank A. Chervenak, Laurence B Mccullough
    Abstract:

    In this chapter, we provide an account of the Professional Responsibility model of obstetric ethics, and identify its implications for two major topics: patient-choice caesarean delivery and trial of labour after caesarean delivery. The Professional Responsibility model of obstetric ethics is based on the ethical concept of medicine as a profession and the ethical principles of beneficence and respect for autonomy. The obstetrician has beneficence-based and autonomy-based obligations to the pregnant woman and beneficence-based obligations to the fetus when it is a patient. Because the viable fetus is a patient, the ethics of caesarean delivery requires balancing of obligations to the pregnant and fetal patient. The implication of the Professional Responsibility model for patient-choice caesarean delivery is that the obstetrician should respond to such requests with a recommendation against non-indicated caesarean delivery and for vaginal delivery. These recommendations should be explained and discussed in the informed consent process. It is ethically permissible to implement an informed, reflective decision for non-indicated caesarean delivery. The implication for trial of labour after caesarean delivery is that, in settings properly equipped and staffed, the obstetrician should offer both trial of labour after caesarean delivery and planned caesarean delivery to women who have had one previous low transverse incision. The obstetrician should recommend against trial of labour after caesarean delivery for women with a previous classical incision.

  • The Professional Responsibility Model of Ethics in Perinatal Medicine
    Journal of Health and Medical Informatics, 2013
    Co-Authors: Frank A. Chervenak, Laurence B Mccullough
    Abstract:

    Objective: To describe the Professional Responsibility model of ethics in perinatal medicine, based on the fetus and pregnant woman as patients, to guide the deliberative practice of perinatal medicine. Methods: We describe secular medical ethics and its two fundamental principles, beneficence and respect for autonomy. We articulate the ethical concept of the fetus as a patient on the basis of the ethical principle of beneficence. Results: In the deliberative practice of perinatal medicine guided by the Professional Responsibility model, the perinatologist should always identify and balance beneficence-based obligations to the fetal patient and beneficence-based and autonomy-based obligations to the pregnant patient. Directive counseling is appropriate when the fetus is a patient. Non-directive counseling is appropriate when the fetus is not a patient. Conclusion: Counseling pregnant women about the clinical management of their pregnancies should always identify and balance beneficence-based obligations to the fetal patient and beneficence-based and autonomy-based obligations to the pregnant patient.

  • the Professional Responsibility model of physician leadership
    American Journal of Obstetrics and Gynecology, 2013
    Co-Authors: Frank A. Chervenak, Laurence B Mccullough, Robert L Brent
    Abstract:

    The challenges physician leaders confront today call to mind Odysseus' challenge to steer his fragile ship successfully between Scylla and Charybdis. The modern Scylla takes the form of ever-increasing pressures to provide more resources for Professional liability, compliance, patient satisfaction, central administration, and a host of other demands. The modern Charybdis takes the form of ever-increasing pressures to procure resources when fewer are available and competition is continuously increasing the need for resources, including managed care, hospital administration, payers, employers, patients who are uninsured or underinsured, research funding, and philanthropy. This publication provides physician leaders with guidance for identifying and managing common leadership challenges on the basis of the Professional Responsibility model of physician leadership. This model is based on Plato's concept of leadership as a life of service and the Professional medical ethics of Drs John Gregory and Thomas Percival. Four Professional virtues should guide physician leaders: self-effacement, self-sacrifice, compassion, and integrity. These Professional virtues direct physician leaders to treat colleagues as ends in themselves, to provide justice-based resource management, to use power constrained by medical Professionalism, and to prevent and respond effectively to organizational dysfunction. The Professional Responsibility model guides physician leaders by proving an explicit "tool kit" to complement managerial skills.

Robert L Brent - One of the best experts on this subject based on the ideXlab platform.

  • ethics and Professional Responsibility essential dimensions of planned home birth
    Seminars in Perinatology, 2016
    Co-Authors: Laurence B Mccullough, Robert L Brent, Amos Grunebaum, Birgit Arabin, Malcolm I Levene, Frank A. Chervenak
    Abstract:

    Abstract Planned home birth is a paradigmatic case study of the importance of ethics and Professionalism in contemporary perinatology. In this article we provide a summary of recent analyses of the Centers for Disease Control database on attendants and birth outcomes in the United States. This summary documents the increased risks of neonatal mortality and morbidity of planned home birth as well as bias in Apgar scoring. We then describe the Professional Responsibility model of obstetric ethics, which is based on the Professional medical ethics of two major figures in the history of medical ethics, Drs. John Gregory of Scotland and Thomas Percival of England. This model emphasizes the identification and careful balancing of the perinatologist’s ethical obligations to pregnant, fetal, and neonatal patients. This model stands in sharp contrast to one-dimensional maternal-rights-based reductionist model of obstetric ethics, which is based solely on the pregnant woman’s rights. We then identify the implications of the Professional Responsibility model for the perinatologist’s role in directive counseling of women who express an interest in or ask about planned home birth. Perinatologists should explain the evidence of the increased, preventable perinatal risks of planned home birth, recommend against it, and recommend planned hospital birth. Perinatologists have the Professional Responsibility to create and sustain a strong culture of safety committed to a home-birth-like experience in the hospital. By routinely fulfilling these Professional responsibilities perinatologists can help to prevent the documented, increased risks planned home birth.

  • the Professional Responsibility model of physician leadership
    American Journal of Obstetrics and Gynecology, 2013
    Co-Authors: Frank A. Chervenak, Laurence B Mccullough, Robert L Brent
    Abstract:

    The challenges physician leaders confront today call to mind Odysseus' challenge to steer his fragile ship successfully between Scylla and Charybdis. The modern Scylla takes the form of ever-increasing pressures to provide more resources for Professional liability, compliance, patient satisfaction, central administration, and a host of other demands. The modern Charybdis takes the form of ever-increasing pressures to procure resources when fewer are available and competition is continuously increasing the need for resources, including managed care, hospital administration, payers, employers, patients who are uninsured or underinsured, research funding, and philanthropy. This publication provides physician leaders with guidance for identifying and managing common leadership challenges on the basis of the Professional Responsibility model of physician leadership. This model is based on Plato's concept of leadership as a life of service and the Professional medical ethics of Drs John Gregory and Thomas Percival. Four Professional virtues should guide physician leaders: self-effacement, self-sacrifice, compassion, and integrity. These Professional virtues direct physician leaders to treat colleagues as ends in themselves, to provide justice-based resource management, to use power constrained by medical Professionalism, and to prevent and respond effectively to organizational dysfunction. The Professional Responsibility model guides physician leaders by proving an explicit "tool kit" to complement managerial skills.

Laurence B Mccullough - One of the best experts on this subject based on the ideXlab platform.

  • the Professional Responsibility model of ethics in obstetrics and gynecology
    2018
    Co-Authors: Frank A. Chervenak, Laurence B Mccullough
    Abstract:

    The Professional Responsibility model of ethics in obstetrics and gynecology should guide decision-making and behavior in clinical practice, research, and education. The model is based on the ethical concept of medicine as a profession, introduced into the histories of medicine and medical ethics by the Scottish physician-ethicist, John Gregory (1724–1773), and the English physician-ethicist, Thomas Percival (1740–1804). They showed that, to be a Professional in the ethically significant sense of the word, physicians should commit themselves to scientific and clinical excellence and to the protection of the patient’s health-related interest, keeping self-interest systematically secondary. To fulfill these commitments, physicians should cultivate the Professional virtues of integrity, compassion, and self-sacrifice and conform clinical practice to the ethical principles of beneficence and self-sacrifice. The Professional Responsibility model uses these ethical concepts to create an account of the obstetrician-gynecologist’s ethical obligations to pregnant, fetal, and neonatal patients. The implications of virtue-based, beneficence-based, and autonomy-based obligations to patients must be all considered to reach deliberative judgments about Professionally responsible patient care, research, and education.

  • ethics and Professional Responsibility essential dimensions of planned home birth
    Seminars in Perinatology, 2016
    Co-Authors: Laurence B Mccullough, Robert L Brent, Amos Grunebaum, Birgit Arabin, Malcolm I Levene, Frank A. Chervenak
    Abstract:

    Abstract Planned home birth is a paradigmatic case study of the importance of ethics and Professionalism in contemporary perinatology. In this article we provide a summary of recent analyses of the Centers for Disease Control database on attendants and birth outcomes in the United States. This summary documents the increased risks of neonatal mortality and morbidity of planned home birth as well as bias in Apgar scoring. We then describe the Professional Responsibility model of obstetric ethics, which is based on the Professional medical ethics of two major figures in the history of medical ethics, Drs. John Gregory of Scotland and Thomas Percival of England. This model emphasizes the identification and careful balancing of the perinatologist’s ethical obligations to pregnant, fetal, and neonatal patients. This model stands in sharp contrast to one-dimensional maternal-rights-based reductionist model of obstetric ethics, which is based solely on the pregnant woman’s rights. We then identify the implications of the Professional Responsibility model for the perinatologist’s role in directive counseling of women who express an interest in or ask about planned home birth. Perinatologists should explain the evidence of the increased, preventable perinatal risks of planned home birth, recommend against it, and recommend planned hospital birth. Perinatologists have the Professional Responsibility to create and sustain a strong culture of safety committed to a home-birth-like experience in the hospital. By routinely fulfilling these Professional responsibilities perinatologists can help to prevent the documented, increased risks planned home birth.

  • the Professional Responsibility model of obstetric ethics and caesarean delivery
    Best Practice & Research in Clinical Obstetrics & Gynaecology, 2013
    Co-Authors: Frank A. Chervenak, Laurence B Mccullough
    Abstract:

    In this chapter, we provide an account of the Professional Responsibility model of obstetric ethics, and identify its implications for two major topics: patient-choice caesarean delivery and trial of labour after caesarean delivery. The Professional Responsibility model of obstetric ethics is based on the ethical concept of medicine as a profession and the ethical principles of beneficence and respect for autonomy. The obstetrician has beneficence-based and autonomy-based obligations to the pregnant woman and beneficence-based obligations to the fetus when it is a patient. Because the viable fetus is a patient, the ethics of caesarean delivery requires balancing of obligations to the pregnant and fetal patient. The implication of the Professional Responsibility model for patient-choice caesarean delivery is that the obstetrician should respond to such requests with a recommendation against non-indicated caesarean delivery and for vaginal delivery. These recommendations should be explained and discussed in the informed consent process. It is ethically permissible to implement an informed, reflective decision for non-indicated caesarean delivery. The implication for trial of labour after caesarean delivery is that, in settings properly equipped and staffed, the obstetrician should offer both trial of labour after caesarean delivery and planned caesarean delivery to women who have had one previous low transverse incision. The obstetrician should recommend against trial of labour after caesarean delivery for women with a previous classical incision.

  • The Professional Responsibility Model of Ethics in Perinatal Medicine
    Journal of Health and Medical Informatics, 2013
    Co-Authors: Frank A. Chervenak, Laurence B Mccullough
    Abstract:

    Objective: To describe the Professional Responsibility model of ethics in perinatal medicine, based on the fetus and pregnant woman as patients, to guide the deliberative practice of perinatal medicine. Methods: We describe secular medical ethics and its two fundamental principles, beneficence and respect for autonomy. We articulate the ethical concept of the fetus as a patient on the basis of the ethical principle of beneficence. Results: In the deliberative practice of perinatal medicine guided by the Professional Responsibility model, the perinatologist should always identify and balance beneficence-based obligations to the fetal patient and beneficence-based and autonomy-based obligations to the pregnant patient. Directive counseling is appropriate when the fetus is a patient. Non-directive counseling is appropriate when the fetus is not a patient. Conclusion: Counseling pregnant women about the clinical management of their pregnancies should always identify and balance beneficence-based obligations to the fetal patient and beneficence-based and autonomy-based obligations to the pregnant patient.

  • the Professional Responsibility model of physician leadership
    American Journal of Obstetrics and Gynecology, 2013
    Co-Authors: Frank A. Chervenak, Laurence B Mccullough, Robert L Brent
    Abstract:

    The challenges physician leaders confront today call to mind Odysseus' challenge to steer his fragile ship successfully between Scylla and Charybdis. The modern Scylla takes the form of ever-increasing pressures to provide more resources for Professional liability, compliance, patient satisfaction, central administration, and a host of other demands. The modern Charybdis takes the form of ever-increasing pressures to procure resources when fewer are available and competition is continuously increasing the need for resources, including managed care, hospital administration, payers, employers, patients who are uninsured or underinsured, research funding, and philanthropy. This publication provides physician leaders with guidance for identifying and managing common leadership challenges on the basis of the Professional Responsibility model of physician leadership. This model is based on Plato's concept of leadership as a life of service and the Professional medical ethics of Drs John Gregory and Thomas Percival. Four Professional virtues should guide physician leaders: self-effacement, self-sacrifice, compassion, and integrity. These Professional virtues direct physician leaders to treat colleagues as ends in themselves, to provide justice-based resource management, to use power constrained by medical Professionalism, and to prevent and respond effectively to organizational dysfunction. The Professional Responsibility model guides physician leaders by proving an explicit "tool kit" to complement managerial skills.

Vicky Gannon - One of the best experts on this subject based on the ideXlab platform.

Paul Callister - One of the best experts on this subject based on the ideXlab platform.

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