Obstetrics & Gynecology>>>>>Ethical and Legal Issues in Obstetrics and Gynecology
Question 4#

A 27-year-old woman who has previously received no prenatal care presents at term. On ultrasound, she is shown to have a placenta previa, but refuses to have a cesarean delivery under any circumstances.

Important points to consider in her management include which of the following?

A) The obstetrician’s obligation to the supposedly normal fetus supersedes the obligation to the healthy mother
B) The inclusion of several people in this complex situation raises the legal risk to the physician
C) Child abuse statutes require the physician to get a court order to force a cesarean delivery
D) Court-ordered cesarean deliveries have almost always been determined to achieve the best management
E) A hospital ethics committee should be convened to evaluate the situation

Correct Answer is E

Comment:

When confronted by a complex situation in which there are conflicting values and rights, getting the most qualified people involved is the best approach to reduce risk and to come up with the best, most defensible answer under the current circumstances. The obstetrician should employ whatever departmental or hospital resources are available. A standing ethics committee or an ad hoc committee to deal with such complex situations is often available, and will minimize the ultimate medicolegal problems that can ensue when bad outcomes seem likely. The obstetrician must further recognize that he or she has two patients, but that it is not clear, nor is it legislated, whose interests take priority. However, general ethical opinion is that the mother usually should come first. Most court-ordered cesarean deliveries have been performed on patients who were estranged from the medical system, and this sets a very bad precedent for further state intervention in doctor-patient relationships and maternal rights. Child abuse statutes do not, at this point, require a court order to force a cesarean delivery, even for a healthy fetus.