Professional integrity in maternal – fetal innovation and research: an essential component of perinatal medicine
-
Laurence B. McCullough
,
John H. Coverdale
Abstract
Objectives
Clinical innovation and research on maternal–fetal interventions have become an essential for the development of perinatal medicine. In this paper, we present an ethical argument that the professional virtue of integrity should guide perinatal investigators.
Methods
We present an historical account of the professional virtue of integrity and the key distinction that this account requires between intellectual integrity and moral integrity.
Results
We identify implications of both intellectual and moral integrity for innovation, research, prospective oversight, the role of equipoise in randomized clinical trials, and organizational leadership to ensure that perinatal innovation and research are conducted with professional integrity.
Conclusions
Perinatal investigators and those charged with prospective oversight should be guided by the professional virtue of integrity. Leaders in perinatal medicine should create and sustain an organizational culture of professional integrity in fetal centers, where perinatal innovation and research should be conducted.
-
Research funding: None declared.
-
Author contribution: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
-
Competing interests: Authors state no conflict of interest.
-
Informed consent: Not applicable.
-
Ethical approval: Not applicable.
References
1. McCullough, LB, Coverdale, JH, Chervenak, FA. Professional ethics in obstetrics and gynecology. Cambridge: Cambridge University Press; 2020.10.1017/9781316841037Search in Google Scholar
2. Scott Adzick, N, Thom, EA, Spong, CY, Brock, JW, Burrows, PK, Johnson, MP, et al.. For the MOMS investigators. A randomized trial of prenatal versus postnatal repair of myelomeningocele. N Engl J Med 2011;364:993–1004. https://doi.org/10.1056/nejmoa1014379.Search in Google Scholar PubMed PubMed Central
3. Van der Veeken, L, Russo, FM, De Catte, L, Gratacos, E, Benachi, A, Ville, Y, et al.. Fetoscopic endoluminal tracheal occlusion and reestablishment of fetal airways for congenital diaphragmatic hernia. Gynecol Surg 2018;15:9. https://doi.org/10.1186/s10397-018-1041-9.Search in Google Scholar PubMed PubMed Central
4. Deprest, J, Brady, P, Nicolaides, K, Benachi, A, Berg, C, Vermeesch, J, et al.. Prenatal management of the fetus with isolated congenital diaphragmatic hernia in the era of the TOTAL trial. Semin Fetal Neonatal Med 2014;19:338–48. https://doi.org/10.1016/j.siny.2014.09.006.Search in Google Scholar PubMed
5. Kanade, R, Shazly, S, Ruano, R. Interventions and neonatal outcomes of fetuses with hypoplastic left heart syndrome and congenital diaphragmatic hernia: a systematic review. J Matern Fetal Neonatal Med 2020:1–12. https://doi.org/10.1080/14767058.2020.1849091.Search in Google Scholar PubMed
6. Willborg, BE, Ibirogba, ER, Trad, ATA, Sbragia, L, Potter, D, Ruano, R. Is there a role for fetal interventions in gastroschisis management? - an updated comprehensive review. Prenat Diagn 2021;41:159–76. https://doi.org/10.1002/pd.5820.Search in Google Scholar PubMed
7. Moise Jr, KJ, Johnson, A, Tsao, K. Certification process of fetal centers in Texas and developing national guidelines. Obstet Gynecol 2020;135:141–7. https://doi.org/10.1097/aog.0000000000003599.Search in Google Scholar
8. North American Fetal Therapy Network (NAFTNet). Available at North American Fetal Therapy Network (NAFTNet) | NAFTNet, accessed February 17, 2021.Search in Google Scholar
9. Jelin, AC, Sagaser, KG, Forster, KR, Ibekwe, T, Norton, ME, Jelin, EB. Etiology and management of early pregnancy renal anhydramnios: is there a place for serial amnioinfusions?. Prenat Diagn 2020;40:528–37. https://doi.org/10.1002/pd.5658.Search in Google Scholar PubMed PubMed Central
10. Beauchamp, TL, Childress, JF. Principles of biomedical ethics, 8th ed. New York: Oxford University Press; 2019.Search in Google Scholar
11. McCullough, LB. John Gregory and the invention of professional medical ethics and the profession of medicine. Dordrecht: Kluwer Academic Publishers (now Springer); 1998. https://doi.org/10.1007/978-0-585-27162-0.Search in Google Scholar
12. Gilligan, C. In a Different voice: psychological theory and women’s development. Cambridge: Harvard University Press; 1982.Search in Google Scholar
13. Tong, R. The ethics of care: a feminist virtue ethics of care for healthcare practitioners. J Med Philos 1998;23:131–52. https://doi.org/10.1076/jmep.23.2.131.8921.Search in Google Scholar PubMed
14. Plato. Republic. In: Cooper, JM, Hutchinson, DS, editors Plato complete works. Indianapolis: Hackett Publishing Company; 1997. pp. 971–1223.Search in Google Scholar
15. Pellegrino, ED. Physician integrity: why it is inviolable. Hastings Cent Rep 2009;18–20.Search in Google Scholar
16. Biffl, WL, Spain, DA, Reitsma, AM, Minter, RM, Upperman, J, Wilson, M, et al.. Society of University surgeons surgical innovations project team. Responsible development and application of surgical innovations: a position statement of the society of University surgeons. J Am Coll Surg 2008;206:1204–9. https://doi.org/10.1016/j.jamcollsurg.2008.02.011.Search in Google Scholar
17. Brody, BA, McCullough, LB, Sharp, R. Consensus and controversy in research ethics. J Am Med Assoc 2005;294:1411–4. https://doi.org/10.1001/jama.294.11.1411.Search in Google Scholar
18. Ville, Y. Fetal therapy: practical ethical considerations. Prenat Diagn 2011;31:621–7. https://doi.org/10.1002/pd.2808.Search in Google Scholar
19. Vergote, S, Pizzolato, D, Russo, F, Dierickx, K, Deprest, J, Crombag, N. The TOTAL trial dilemma: a survey among professionals on equipoise regarding fetal therapy for severe congenital diaphragmatic hernia. Prenat Diagn 2021;41:179–89. https://doi.org/10.1002/pd.5849.Search in Google Scholar
20. Deprest, J. Prenatal treatment of severe congenital diaphragmatic hernia: there is still medical equipoise. Ultrasound Obstet Gynecol 2020;56:493–7. https://doi.org/10.1002/uog.22182.Search in Google Scholar
21. Morris, RK, Malin, GL, Quinlan-Jones, E, Middleton, LJ, Hemming, K, Burke, D, et al.. Percutaneous vesicoamniotic shunting in Lower Urinary Tract Obstruction (PLUTO) Collaborative Group. Percutaneous vesicoamniotic shunting versus conservative management for fetal lower urinary tract obstruction (PLUTO): a randomised trial. Lancet 2013;382:1496–506. https://doi.org/10.1016/s0140-6736(13)60992-7.Search in Google Scholar
22. Van Mieghem, T, Ryan, G. The PLUTO trial: a missed opportunity. Lancet 2013;382:1471–3. https://doi.org/10.1016/s0140-6736(13)61446-4.Search in Google Scholar
23. Coverdale, JH, Roberts, LW, Balon, R, Beresin, EV, Louie, AK, Guerrero, AP, et al.. Professional integrity and the role of medical students in professional self-regulation. Acad Psychiatr 2016;40:525–9. https://doi.org/10.1007/s40596-016-0534-y.Search in Google Scholar PubMed
24. Jochemsen-van der Leeuw, HG, van Dijk, N, van Etten-Jamaludin, FS, Wieringa-de Waard, M. The attributes of the clinical trainer as a role model: a systematic review. Acad Med 2013;88:26–34. https://doi.org/10.1097/acm.0b013e318276d070.Search in Google Scholar
© 2021 Walter de Gruyter GmbH, Berlin/Boston
Articles in the same Issue
- Frontmatter
- Review
- Global incidence of intraventricular hemorrhage among extremely preterm infants: a systematic literature review
- Commentary
- Professional integrity in maternal – fetal innovation and research: an essential component of perinatal medicine
- WAPM Recommendations
- WAPM-World Association of Perinatal Medicine Practice Guidelines: Fetal central nervous system examination
- Corner of Academy
- Education in developing countries and reducing maternal mortality: a forgotten piece of the puzzle?
- Original Articles – Obstetrics
- The contemporary value of dedicated preterm birth clinics for high-risk singleton pregnancies: 15-year outcomes from a leading maternal centre
- Chorioamnionitis after premature rupture of membranes in nulliparas undergoing labor induction: prostaglandin E2 vs. oxytocin
- Maternal and fetal outcomes in pregnancies with obstructive sleep apnea
- Assessing the involvement of the placental microbiome and virome in preeclampsia using non coding RNA sequencing
- Risk of metformin failure in the treatment of women with gestational diabetes
- Can we improve our ability to interpret category II fetal heart rate tracings using additional clinical parameters?
- New obstetric systemic inflammatory response syndrome criteria for early identification of high-risk of sepsis in obstetric patients
- Bacteria in the amniotic fluid without inflammation: early colonization vs. contamination
- Intertwin differences in umbilical artery pulsatility index are associated with infant survival in twin-to-twin transfusion syndrome
- Maternal and neonatal outcomes in women with disorders of lipid metabolism
- The use of PAMG-1 testing in patients with preterm labor, intact membranes and a short sonographic cervix reduces the rate of unnecessary antenatal glucocorticoid administration
- Original Articles – Neonates
- The effect of postnatal corticosteroids on growth parameters in infants with bronchopulmonary dysplasia
- Are neonatal outcomes of triplet pregnancies different from those of singletons according to gestational age?
- Impact of paternal presence and parental social-demographic characteristics on birth outcomes
- Letter to the Editor
- Comment on: “amniotic fluid embolism – implementation of international diagnosis criteria and subsequent pregnancy recurrence risk”
Articles in the same Issue
- Frontmatter
- Review
- Global incidence of intraventricular hemorrhage among extremely preterm infants: a systematic literature review
- Commentary
- Professional integrity in maternal – fetal innovation and research: an essential component of perinatal medicine
- WAPM Recommendations
- WAPM-World Association of Perinatal Medicine Practice Guidelines: Fetal central nervous system examination
- Corner of Academy
- Education in developing countries and reducing maternal mortality: a forgotten piece of the puzzle?
- Original Articles – Obstetrics
- The contemporary value of dedicated preterm birth clinics for high-risk singleton pregnancies: 15-year outcomes from a leading maternal centre
- Chorioamnionitis after premature rupture of membranes in nulliparas undergoing labor induction: prostaglandin E2 vs. oxytocin
- Maternal and fetal outcomes in pregnancies with obstructive sleep apnea
- Assessing the involvement of the placental microbiome and virome in preeclampsia using non coding RNA sequencing
- Risk of metformin failure in the treatment of women with gestational diabetes
- Can we improve our ability to interpret category II fetal heart rate tracings using additional clinical parameters?
- New obstetric systemic inflammatory response syndrome criteria for early identification of high-risk of sepsis in obstetric patients
- Bacteria in the amniotic fluid without inflammation: early colonization vs. contamination
- Intertwin differences in umbilical artery pulsatility index are associated with infant survival in twin-to-twin transfusion syndrome
- Maternal and neonatal outcomes in women with disorders of lipid metabolism
- The use of PAMG-1 testing in patients with preterm labor, intact membranes and a short sonographic cervix reduces the rate of unnecessary antenatal glucocorticoid administration
- Original Articles – Neonates
- The effect of postnatal corticosteroids on growth parameters in infants with bronchopulmonary dysplasia
- Are neonatal outcomes of triplet pregnancies different from those of singletons according to gestational age?
- Impact of paternal presence and parental social-demographic characteristics on birth outcomes
- Letter to the Editor
- Comment on: “amniotic fluid embolism – implementation of international diagnosis criteria and subsequent pregnancy recurrence risk”
