208 © 2003 Royal College of Obstetricians and Gynaecologists Background Doctors are highly regarded professionals; 89% of the public trust doctors to tell them the truth (still more than any other profession). 1 Unfortunately, events have illustrated that a considerable gap can exist between what society and some doctors view as ethical practice. Ian Kennedy, the chairman of the Bristol Inquiry, 2 described a mindset of ‘professional hubris’ at the Bristol Royal Infirmary and a ‘lack of insight’ and ‘(ethically) flawed’ behaviour. The organ retention scandal at Alder Hey also illustrated this disparity. Despite the fact that most of the doctors involved 3 practiced within the strict letter of the law (the Human Tissue Act of 1961 4 gives ownership of a corpse to those in possession of the body, not the surviving relatives), society considered the retention of children’s organs without their parents’ know- ledge or fully informed consent as shocking and unacceptable. 5 Obstetricians and gynaecologists deal with the beginnings of human life and are often involved in complex decision making. Unlike any other medical specialty they may legally kill an entity, which in other circumstances they would describe as one of their patients. 6 In this context the importance of consistent and relevant ethical practice is obvious. But what is this? What are the rules that dictate it? These are difficult questions to answer in a multicultural society with a plurality of ethical codes. It has been argued that one of the consequences of the decline of a single, dominant, (Christian) philosophical perspective in British society has been the abandonment, by many, of the notion of a single ‘objective truth’; the concept that for any given ethical dilemma there is a single right or wrong answer. 7 Indeed some have suggested that it has become one of the pronounced features of the modern era that as ethical problems have multiplied, society’s capacity to come to some sort of moral (as opposed to legal) consensus appears to be diminishing. 8 What is Ethics? Ethics is the science of morals, the branch of philosophy that is concerned with human character and conduct.Thus any,and every,action within the doctor–patient relationship will have an ethical dimension. Generally our own systems of morals and rules of behaviour have become so ingrained in our day-to-day practice that we do not give them a second thought. Most doctors automatically respect confidentiality, for example, and would treat all information from a clinical setting as privileged. However, there are occasions when it may be unethical to maintain confidentiality.An example might be if a doctor became aware that a patient was setting out to murder another person. Should one maintain confidentiality or warn the intended victim? The answer may be obvious to you but doctors in this position have been taken to court both for maintaining 9 and breaking confidentiality. 10 In a society where many people have different ethical perspectives any position adopted by an obstetrician or gynaecologist might be challenged. It is, therefore, important to be able to explain how a particular ethical conclusion has been reached. Intuition may be quick but it can also be fallible. Rational and logical arguments are less likely to be prejudiced, although they can appear cold and calculating in emotionally charged clinical situations. Ethical frameworks for obstetrics and gynaecology Susan Bewley, Martin Lupton Most aspects of the doctor–patient relationship have an ethical dimension and the potential to pose ethical dilemmas. The depth and breadth of ethical issues in obstetrics and gynaecology cannot possibly be covered in a short article. However, this article offers a guide to help discussion. Three main philosophical frameworks used by professional ethicists to examine ethical dilemmas are described, together with some of their methodology. We end with some practical suggestions of how to avoid ethical conflicts and of how to approach ethical dilemmas when they arise. Author details ETHICS The Obstetrician & Gynaecologist 2003;5:208–13 Keywords doctor–patient relationship, ethical dilemmas, ethics, philosophical frameworks. Susan Bewley MA MD FRCOG, Clinical Director, Women’s Health Services, Guy’s and St Thomas’ Hospitals Trust, Lambeth Palace Road, London SE1 7EH, UK. email: susan.bewley@gstt.sthames.nhs.uk (corresponding author) Martin Lupton MA MRCOG, Perinatal Fellow, The Department of Maternal/Fetal Medicine, The Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK. email: martin@glupton.fsnet.co.uk