RESPONDING PROFESSIONALLY TO REQUESTS FOR CESAREAN DELIVERY

Patients' requests for non-indicated cesarean delivery challenge the professionalism of obstetricians. This is because physicians should not provide clinical management in the absence of an evidence-based indication for it. The ethics of responding professionally to requests for non-indicated cesarean delivery would appear to be simple: just say "No." This paper presents an ethically and clinically more nuanced approach, on the basis of the professional responsibility model of obstetric ethics, emphasizinga preventive ethics approach. Preventive ethics deploys the informed consent process to minimize ethical conflict in clinical practice. This process should focus on when to recommend against cesarean delivery - rather than simply saying no. There is no evidence of net clinical benefit for pregnant, fetal, and neonatal patients from non-indicated cesarean delivery. Obstetricians should therefore respond to such requests by recommending against cesarean delivery, recommending vaginal delivery, and explaining the evidence base for these recommendations.