Ethical Dilemmas in Healthcare: A Case Study on Prenatal Diagnosis

This case study delves into the ethical dilemmas arising from a midwife (Sarah) informing parents (Natalia and Dylan) about a prenatal Down syndrome diagnosis. It examines Sarah's breach of confidentiality by discussing the case with colleagues, her personal views on terminating pregnancies with Down syndrome, and whether she overstepped her role by directly informing the parents instead of an obstetrician. The analysis extends to human rights considerations, professional codes of conduct for midwives, relevant abortion legislation in Australia, and core principles of healthcare ethics, including patient autonomy and non-maleficence. Ultimately, the study recommends that midwives should not directly disclose such diagnoses, maintain patient confidentiality, and avoid imposing personal biases regarding termination.

Health Care Ethics 1
Health Care Ethics

Health Care Ethics 2
Introduction
In this essay, there is the discussion of the case study. Natalia is going through a pregnancy.
Sarah, a midwife is working in the midwifery-led antennal clinic. Natalia comes to this clinic
for the trimester ultrasound test. In the test, it was found that pre-born baby is having Down
syndrome. Sarah informs this report to the parent directly. The ethical issues that take place
in this situation are discussed in this assessment. The issues in context with the human right
are analysed in this assessment. After that, there is the analysis of a professional code of
ethics that can be followed by Sarah. The laws regarding the abortion and ultrasound are
investigated in this assessment. The Healthcare ethics principles are also analysed in this
assessment.
Ethical issue
As prescribed by (Hill, et. al., 2012), it is very necessary to provide exact information about
the foetus to the parent. Information is always beneficial for the parents. Information is
having an implication on the future of the family. If the unwanted information is provided to
the parent then it can be harmful to a family. The parent can come on the difficult decision on
continuing the pregnancy or not. The ethical issue rose from the case studythat Sarah is
breaching important information of Natalia and Dylan to the co-workers. It is not the right of
Sarah to reveal the information to any of the employees that are working in the clinic.
Though one of the co-workers is involved in social welfare it is the choice of Natalia that to
whom she won't disclose this information(Hill, et. al., 2012).
Sarah discloses the information to one of the workers from the labour ward. This is also not
the practice of ethics that is being followed by Sarah. The reply from the test an employee of
the labour ward regarding this pregnancy was also unethical. He was encouraging the belief
of terminating a Down syndrome child. Sarah point of view regarding this pregnancy is also

Health Care Ethics 3
not in the favour of childbirth. Sarah also believes that raising the disabled child is not an
easy task. She is also in the favour of terminating pre-born babies who are having Down
syndrome. Being working as a midwife it is not acceptable from Sarah that she is having such
type of point view regarding free born babies that are having Down syndrome. This is the
unethical practice of thinking and promoting such type of thoughts from Sarah. by seeing
such type of reaction from Sarah it can be said that Sarah may also suggest other parents in
the future of terminating child by giving a reason it is not an easy task to raise up a disabled
child. Sarah is only having the right who suggest Natalia about obstetrician and the social
worker. Further, it is the choice of the parent that they want to continue with this child or not.
It is the totally unethical practice of breathing information about a pre-born child of Natalia.
Reacting in favour of terminating to a parent and other members that are working in the clinic
is also the unethical behaviour of Sarah (Kellogg, et. al., 2014). Sarah is only the midwife.
Sarah is not an obstetrician. It is the responsibility of Sarah that she should not give the
information to the parents directly. It is the responsibility of doctor that can give the right
information on the behalf of the report of ultrasound. Therefore this is also an unethical
behaviour that is followed by Sarah.
Ethical issues in relation to
The notion of human dignity and human rights
According to Lewis, et. al., (2013), it is an unwanted anxiety for a parent to know about
Down syndrome of the Preborn baby. There are many cases in which it is found that
ultrasound shows negative results. Many of the babies are born as a healthy child, by
negating the report of ultrasound of Down syndrome. There can be a situation in which
chromosomal translocation is possible. The presence of choroid plexus cyst results in no
impact on the health of the child. Parent-child interaction also affects because of the
information which is given internally to the parents. The perception of the parents towards

Health Care Ethics 4
the baby will also be changed after the baby will bear because of the information of Down
syndrome of a child. Parents will consider that child with some low abilities even then the
child gets born healthy.
As per Dondorp, et. al., (2015), there is two type of situation that takes place after knowing
the foetus abnormality. Some of the parents take it gratefully. On the basis of this
information, they take a decision to continue with the pregnancy or not. Some of the parents
if terminate that baby then it can have the adverse effect on the particular person of the family
that is having the same disability. This will make a disable person in stress.
Professional code of ethics/conduct
The professional code of ethics in the situation can be it is the responsibility of midwife to
ask the parent about the information they want from the ultrasound test of the trimester. It
was the unethical practice of Sarah that she didn’t ask from Natalia and Dylan about their
wish regarding the information. She does the routine check-up and directly gives the
information to the parent that is also not ethical totally. It is the doctor who gives the
description of a report that is conducted by the midwife. The midwife is not having the
responsibility to report directly to the parents about the health of the foetus (McGillivray, et.
al., 2012). The midwives wrong in the context of providing information. The midwife is not
having that much knowledge that the particular doctor or the obstetrician is having. The
suggestion of obstetrician by the midwife was good ethical practice. When the Sarah reveals
the information of Natalia to the other employees of the organisation is also an unethical
practice that is followed by this lady. It is very hard to choose whether to terminate a foetus
in which the abnormality is found. There can be the situation in which the parent did not
focus on the abnormality of a child. They have two ways the child with full of responsibility
and the best they can do for that child. Therefore asking a parent about the information they
are seeking is the correct code of conduct in this regard.

Health Care Ethics 5
Relevant professional policies and legislation
Australia is having the state-based law regarding the abortion. It is totally the state subject.
Australia is not having a National Law regarding abortion of Baby child. Abortion is legal in
Australian Capital Territory. Abortion is the crime for a doctor as well as women in
Queensland and New South Wales. New social and medical factors can take into account if
the women seek an abortion. Abortion is legal in South Australia is two doctors agree on the
grounds of a Medical and physical condition of women. In Victoria's, it is legal up to 24
weeks. After the 24 weeks, the women have to take permission from two doctors. In
Tasmania and Western Australia abortion is legal for 16 weeks and 20 weeks respectively
then there is a requirement of doctors approval. On the other side and northern territory
permits abortion till 14 weeks with the permission of 1 doctor. For 14 to 23 weeks there is a
requirement of additional doctor permission. After the 23rd week, it is not legal and it is not
performed unless it is performed to save the life of the pregnant person (Brännström, et. al.,
2015).
The principle of Healthcare ethics
It is the right of a particular person to control over his or her body. It is the choice of the
patient to follow the prescription that is advised by the professional or not. The patient must
be allowed to take the decision oneself on the health. It is the responsibility of medical
professionals that they should do their best to cure for the patient (Asplin, et. al., 2012). A
medical professional should maintain the high level of skills for practising. It is the
responsibility of the medical profession not to harm the patient in any condition. The decision
made by the medical professionals should not harm patient and Society. Fair actions should
be followed by the medical practitioner so that injustice will not take place with anyone.
Recommendations
It is recommended that: -

Health Care Ethics 6
Sarah should not reveal the information directly to the parents about the Down syndrome of
the foetus. It is the responsibility of the doctor and Sarah is not a doctor she is a midwife.
Sarah should not breach the information of any patient that goes through such situation Down
syndrome in the foetus.
Sarah is having a view in the favour of terminating a child in the situation of Down
syndrome. It is not are the acceptable situation from the employee that is working as a
midwife. She should not be in favour of baby termination or abortion.
Conclusion
It can be concluded from the case study that there are many ethical issues that take place
because of informing about the down syndrome of the baby child to the parent. Sarah
followed an unethical behaviour with Natalia and Dylan. The information that is provided to
the employees of the clinic is also an unethical practice that is shown by Sarah. Sarah also not
asks from Natalia about the information she is seeking from the ultrasound trimester test. It is
really a stressful situation for Natalia. A proper code of conduct regarding this situation is not
followed by Sarah.

Health Care Ethics 7
References
Asplin, N., Wessel, H., Marions, L., & Öhman, S. G. (2012). Pregnant women’s experiences,
needs, and preferences regarding information about malformations detected by
ultrasound scan. Sexual & Reproductive Healthcare, 3(2), 73-78.
Brännström, M., Johannesson, L., Bokström, H., Kvarnström, N., Mölne, J., Dahm-Kähler,
P., ...& Gäbel, M. (2015). Livebirth after uterus transplantation. The
Lancet, 385(9968), 607-616.
De Jong, A., Maya, I., & Van Lith, J. M. (2015). Prenatal screening: current practice, new
developments, ethical challenges. Bioethics, 29(1), 1-8.
Dondorp, W., De Wert, G., Bombard, Y., Bianchi, D. W., Bergmann, C., Barry, P., ...&
Henneman, L. (2015). Non-invasive prenatal testing for aneuploidy and beyond:
challenges of responsible innovation in prenatal screening. European Journal of
Human Genetics, 23(11), 1438.
Hill, M., Fisher, J., Chitty, L. S., & Morris, S. (2012). Women’s and health professionals’
preferences for prenatal tests for Down syndrome: a discrete choice experiment to
contrast noninvasive prenatal diagnosis with current invasive tests. Genetics in
Medicine, 14(11), 905.
Kellogg, G., Slattery, L., Hudgins, L., & Ormond, K. (2014). Attitudes of mothers of children
with down syndrome towards noninvasive prenatal testing. Journal of genetic
counselling, 23(5), 805-813.
Lewis, C., Silcock, C., & Chitty, L. S. (2013). Non-invasive prenatal testing for Down's
syndrome: pregnant women's views and likely uptake. Public health genomics, 16(5),
223-232.

Health Care Ethics 8
McGillivray, G., Rosenfeld, J. A., McKinlay Gardner, R. J., & Gillam, L. H. (2012). Genetic
counselling and ethical issues with chromosome microarray analysis in prenatal
testing. Prenatal diagnosis, 32(4), 389-395.