Ethical issues in vesico-vaginal fistula care and research

The plight of women in poor nonindustrialized countries who have incurred catastrophic childbirth injuries, such as vesico-vaginal and recto-vaginal fistulas, from prolonged obstructed labor is receiving increased attention from the world medical community. While the good intentions that have prompted this greater concern are not in doubt, intentions by themselves are insufficient guarantees of ethical conduct in programs developed to repair these injuries. Clinical proposals put forward to deal with the problem of fistula must undergo critical analysis to insure that basic ethical requirements are met. This article emphasizes the vulnerability to exploitation of women with obstetric fistulas and reviews the basic principles of medical ethics relevant to fistula care.