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Re: OB:Cesarean for anencephaly From: Betsy Hyde (elishyde@connix.com) Sat Oct 9 20:51:28 1999 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Betsy Hyde: "Re: OB:Cesarean for anencephaly" Previous message: Efrain Ramirez MD: "Re: OB:Cesarean for anencephaly" Maybe in reply to: Sue Turner: "OB:Cesarean for anencephaly" Next in thread: Betsy Hyde: "Re: OB:Cesarean for anencephaly" At 6:57 AM 10/9/99, Armando Fuentes wrote: > >We as physicians do far more cesarean sections than we should, even when it >it morally questionable or when it suits our needs to avoid a litiganous >situation. > >He is a woman who understands the risk of a cesarean section, but who only >asks that she be allowed to hold a "live" baby for however long it has, and >we would deny her that request. I think this is one of those very difficult dilemmas in which two (?three or four) well-accepted precepts of medical ethics conflict...and there's the rub! Patient autonomy and informed consent are in conflict with the physician's charge to first, do no harm. Paternalism is also there, but, of lesser importance. IMO this is one of those value conflicts in which there is no correct answer. The physician cannot be forced to perform surgery which he feels is not in the patient's best interest, yet he should honor his patient's right, as a consenting adult, to make decisions according to her perception of her best interest. Should anyone be able to request, and obtain, an elective c/s without valid medical indications? We all know it happens a fair amount. This situation is somewhat analogous to the situation of the Jehovah's Witness who is bleeding out and refuses blood.....some physicians, following extensive antepartum counseling, would allow that to happen as an example of patient autonomy,respect for religions belief and informed consent. Others would follow the precept to do no harm, and would transfuse, against the patient's wishes. Is one of them right and one of them wrong? I don't know. Many, many years ago I took a course in Medical Ethics at Dartmouth Medical School. The text "Moral Problems in Medicine" Gorovitz et al eds. is still one of my favorite books in my professional library. This course in medical ethics/moral problems in medicine has guided most of my professional career, yet has not prepared me with an answer which I think is correct for this case. I think this is one of those cases that needs lots of time for consultation, sharing of ethical precepts and discussions of all the risks/benefits involved. I've written and deleted multiple conclusions for what I think is correct...and I don't have an answer....other than talk, talk, talk about all the issues involved. Hopefully this woman has selected you because she trusts your judgement, and trusts your ability to elicit and incorporate her wishes into your recommendations. Having said that, do I have an answer to your question? No. -- Betsy Hyde CNM Branford, CT Next message: Betsy Hyde: "Re: OB:Cesarean for anencephaly" Previous message: Efrain Ramirez MD: "Re: OB:Cesarean for anencephaly" Maybe in reply to: Sue Turner: "OB:Cesarean for anencephaly" Next in thread: Betsy Hyde: "Re: OB:Cesarean for anencephaly"

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