Obstetric decision-making: responses to patients who request cesarean delivery

The right of patients to be actively involved in treatment decisions is now widely accepted. A survey of 112 obstetricians was conducted to determine their responses to several cases in which a laboring woman asks for a cesarean section, even though the obstetrician has recommended a continued trial of labor/vaginal delivery. In 12 of the 19 cases there was substantial variation among respondents in the decision to agree with the patient. There was also no agreement, in many of these cases, on the presence or absence of a medical indication for abdominal delivery. The ethical aspects of this problem are explored.