Transcript New approaches in the holistic treatment of women with rejected

New approaches in the holistic
treatment of women with rejected
pregnancy & incomplete abortion
Dr. José David Ortiz Mariscal
Mexico
DECLARATIONS

In my practice as Obstetrician & Gynecologist, I am
guided by the framework of my Constitution, including
treaties, conventions and international declarations
signed by my Government, as well as the legal
framework that regulates health.

In my professional practice, I am guided by scientific
evidence, the principles of public health and
implementation of human, sexual and reproductive rights
of women, in health services.
Declarations

I have practiced obstetrics and Gynecology for 45 years
and I understand that my main goal is to protect and
safeguard my patients health, and in general of all
women.
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I am absolutely against women terminating a pregnancy,
planned or unplanned, in unsafe conditions because it
is unfair and also determines high rates of morbidity and
maternal mortality.
DECLARATIONS:

I have no conflict of interests: economic, social, or religious.
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I am not affiliated with any political party or religious group,
therefore I am not obligated to think, feel and act, as these
institutions impose it to those who belong to them.
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I have spent 40 years of my professional life to the prevention of
high reproductive and obstetric risk factors , promotion of family
planning, responsible sexuality and prevention and
comprehensive management of sexual violence against women.
New approaches for Care
Of women being treated for:
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Unplanned pregnancy
Legal termination of pregnancy
Post abortion period
 HUMAN
PREGNANCY AND
ABORTION
 DOES NOT EXIST
WHAT REALLY EXIST IS
PREGNANT WOMEN!!!!
SO WE HAVE TO CENTER OUR
APROACHES ON THEM.
CONSIDERATIONS
WOMEN with an unplanned and rejected
pregnancy puts herself in a situation of
emotional, physical and social vulnerability.
It may cause injury or death to woman and has
conceived product, if not detected and duly
attended.
Dr. José David Ortiz Mariscal 2013
CONSIDERATION
• Women with unplanned or rejected pregnancy
derivated of high risk biological or social
conditions, should be attended comprehensive
and timely by sensitive and well qualified
multidisciplinary health staff, because failure to
do so will lead a women to terminate her
pregnancy in unsafe conditions, with the results
that all we know.
CONSIDERATION
Every time that a woman has an
unplanned pregnancy or arrives at a
hospital with signs of having tried to
terminate her pregnancy, this means that
the family, the health, religious and
educational sectors and the whole state
has failed.
 It means that we as a society have failed
her.

FIRST APPROACH
Women with Unplanned and Rejected
Pregnancy, during Legal termination of her
Pregnancy or in Post abortion period, must
be treated under the umbrella of sexual
and reproductive rights.
Sexual and reproductive rights
 They
arise from human rights in general,
and are an important part of bioethics.
 They
are applicable to all women.
Women Rights
•The Right to Life: which means among other things that
no woman's life should be put at risk by reason of
pregnancy.
•The Right to Liberty and Security of the Person:
•The Right to Privacy: meaning that all sexual and
reproductive health-care services should be confidential
and all women have the right to independent reproductive
choices.
Women Rights
The Right to Freedom of Thought:
 which includes freedom from the restrictive
interpretation of religious texts, beliefs,
philosophies and customs as tools used to
curtail freedom of thought on sexual and
reproductive health care and other issues.

Women Rights
•The
Right to Information and Education:
•As it relates to sexual and reproductive health for
all, including access to full information and free
and informed consent.
•The
Right to Health Care and Health
Protection: which includes the right of health-care
patients to the highest possible quality of care, and
freedom from traditional practices which are
harmful to health.
Women Rights
•The
Right to the Benefits of Scientific Progress:
Includes the right of sexual and reproductive healthservice clients to new reproductive-health technologies
that are safe, effective and acceptable (MVA, TOP with
medicines).
•The
Right to Freedom of Assembly and Political
participation: which includes the right of all persons to
influence communities and governments to prioritize
sexual and reproductive health and rights
Women Rights
•The
Right to be Free from Torture and Ill-Treatment:
including the rights of all women, and young people
protection from violence, sexual exploitation and abuse.
•The
Right to Equality and to be Free from all Forms of
discrimination: including one’s sexual and reproductive life.
•The
Right to Choose whether or not to marry and to find
and plan a Family (women are not a reproductive
machine).
•The
Right to decide whether or when to have children.
SECOND APPROACH
Be guided by Principles of Bioethics

Beneficence
(maximize the best health outcomes)
Non-maleficence (do no harm)
Autonomy (to ensure and respect the rights of individuals to
make informed decisions about their own health care)
Justice (ensure fairness or fair distribution of costs and
benefits)
Equity (To ensure that everybody gets what is fair for their
needs)
The purpose of human rights is to promote
human dignity implies the obligation of the
States to:
Benefit the physical, mental and social health
of patient in the course of her treatment
(Beneficence)
The commitment not to damage or cause
unnecessary damage. (Non - maleficence)
Bioethics and human rights are related to
sexual and reproductive health
Human rights are protected by:
laws and treaties national and international
Medical ethic is protected by national
constitutions, by codes, primarily controlled by
the medical profession.
ALL WOMEN
Have the right to the highest attainable
health standard and the benefits of
scientific progress:
Form the basis of the professional
commitment of Beneficence and Justice.
Human rights:
To privacy
Freedom of conscience and
The freedom and security of person
To information
Are key elements of autonomy which includes a
duty to protect confidentiality in health care.
THIRD APPOACH:
Consider the Ethical Obligations
of
Health Professionals
Professional competence
To respect the autonomy of
women and the confidentiality
A. Professional competence
1. Achieve and maintain the highest levels of
professional competence in relation to the
health of woman, using the latest and best
medical evidence, in the context of available
resources:
LTOP with medications(mifepristone and
misoprostol and or electrical or manual
vacuum aspiration
A. Professional competence
2. Make a respectful professional behavior
that promotes the dignity and security of
women (not to judge).
A. Professional competence
3. Ensure that the right of the physician to
preserve their own moral or religious values
does not result in the imposition to women
of these personal values.
In these circumstances, women should be
referred to another health care provider who
does not have this problem.
A. Professional competence
The conscientious objection to attend
women for TOP or PAC does not absolve
physicians take steps so that in case of
emergency to provide the necessary
treatment without delay.
Obligations of the Health Professionals
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Professional competence
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Autonomy of women and confidentiality
B. Autonomy of women and confidentiality:
1. Support a process of decision making of
women about their sexual and reproductive
health, free from prejudice and coercion.
Includes:
Act only after obtaining the informed consent or
disagreement, based on adequate information
on the nature, implications of treatment, options
and results of the different available alternatives.
B. Autonomy of women and confidentiality:
By acting in this way, health professionals
respect the right that women consider and
assess treatment options in the context of
their own circumstances
B. Autonomy of women and confidentiality:
2. Ensure the confidentiality, which does not
allow that privileged information and
documents, be shared by verbal mode or in
any other way, except when required by law or
the patient wants it.
Obligations of Health Professionals
My recommendation is to: undertake, adopt and
promote these professional responsibilities, based
on your commitment to make a reality the inclusion
of human rights and bioethical principles in the care
of the reproductive health of women and specially
for the care of women that has decided to terminate
her pregnancy or is in post abortion period.
The reproductive and sexual health is a subject of
human development, since the women are essential
for the social and economic stability and the progress
in all the societies.
The potential contribution of women frequently is not
performed due to limitations in their human rights,
including lack of access to information and to a safe
and proper care of her health.
Conclusions
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Women with unplanned pregnancy deserves to be
served as all other patients:
Under the umbrella of human rights, sexual and
reproductive rights and principles of bioethics
With humanism, with respect
With confidentiality and privacy
Taking care of her physical, emotional and social
integrity.
With counseling
With modern and effective techniques(medical or
surgical as manual aspiration), for LTOP
Contraception post immediate pregnancy termination.
Thank you very much.