女性健康中的伦理问题：病例报告的系统综述

AimThe aim of this systematic review is to identify ethical issues addressed in case reports published between 2016 and 2026 in the field of women's health and to analyze the types and characteristics of these ethical problems.MethodsIn this systematic review, predefined inclusion and exclusion criteria were applied. The inclusion criteria were (i) relevance to women's health (obstetrics, gynecology, and pregnancy), (ii) presence of an ethical dilemma or ethical issue, (iii) being a case report or case series, and (iv) publication between 2016 and 2026. Exclusion criteria were review articles and studies without ethical discussion. The studies were systematically searched in the following databases: PubMed, MEDLINE, Scopus, ScienceDirect, and Google Scholar, with the final search date set as 01.05.2026. The methodological quality of the included case reports was assessed based on CARE Guidelines. Findings were presented thematically.ResultsA total of 17 studies were included. The findings indicate that the conflict between autonomy and beneficence/non-maleficence constitutes the central ethical tension. The most frequently encountered ethical issues were categorized under five main themes: (1) maternal autonomy and fetal beneficence conflict, (2) fertility preservation and urgent medical indications, (3) maternal life-threatening conditions and pregnancy, (4) surrogacy and legal-biological parenthood ambiguity, and (5) vulnerability and end-of-life ethical decision-making. The results show that various ethical frameworks were used, including the four principles of bioethics, the four-box method, prima facie principles, the minus malum principle, the principle of double effect, the Islamic bioethics framework, and shared decision-making approaches.DiscussionThe most fundamental debate concerns the balance between fetal status as a silent patient and maternal autonomy. Cultural and legal frameworks significantly influence decision-making. Multidisciplinary approaches and structured ethical principles are essential.ConclusionEthical dilemmas arise in reproductive autonomy, critical maternal conditions, surrogacy, and vulnerable populations, influenced by cultural and religious contexts.