The Committee upon Ethics of the Am...

The Committee upon Ethics of the American guild of Obstetricians and Gynecologists (ACOG) has released a recent opinion paper addressing the discussion of elective cesarean delivery. "Surgery and Patient Choice: The Ethics of Decision Making," is available online at http://www.acog.org.

While the right of patients to refuse unwanted surgery is well known, les clear is the right of patients to have a surgical performance done when the scientific evidence supporting it is incomplete, of poor quality, or completely lacking.

According to ACOG, when supporting evidence is limited, there is no single answer upon the right ethical response by way of a physician considering a patient's ask for surgery. Thus, the decision onward whether to perform an elective cesarean delivery (also known as "patient choice cesarean" or "cesarean upon demand") will come down to a number of ethical factors, including the patient's transactions and the physician's understanding of the procedure's risks and benefits.

In the case of an elective cesarean delivery, if the physician believes that cesarean delivery aids the overall health and welfare of the woman and her fetus more than does vaginal birth, then he or she is ethically justified in performing a cesarean delivery. Similarly, if the physician believes that performing a cesarean delivery would be detrimental to the overall health and welfare of the woman and her fetus, he or she is ethically obliged to refrain from performing the surgery A referral to another physician would be appropriate if the patient and her physician cannot agree onward a method of delivery.

With regard to changing the policy in support of elective cesarean delivery, ACOG states that the cargo of proof should fall onward those who advocate for the change. Therefore, physicians are beneath no obligation to initiate discussions about a measure such as elective cesarean, that is unproven scientifically or that the individual physician may not consider medically acceptable.

An increasing number of women are requesting elective cesarean instead of vaginal delivery in the belief that the surgery will debar future pelvic support problems, or sexual dysfunction enigmas or for other reasons. A number of physicians believe that of the like kind surgery should not be picked over a natural process without immediate and compelling medical need

ACOG cautions that evidence to support the benefit of elective cesarean is still incomplete and that there are no extensive morbidity and mortality data to compare elective cesarean delivery with vaginal birth in healthy women With better data, there could be a shift in clinical practice.

COPYRIGHT 2004 American Academy of Family Physicians

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