Compelled cesarean section. An ethical perspective

Recent position statements by the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists and the emergence of legal and ethical analyses on the nature of compelled cesarean section have instigated much discussion on how the primary care physician should respond when a pregnant woman refuses to consent to surgery. This article clarifies the ethical obligations of the physician and mother and the nature of their relationships to the fetus. The formulation of an agreement, the physician-mother-fetal contract, is discussed as a teaching tool for helping to clarify the roles of all parties. Also, the function of the primary care physician as proactive educator is highlighted.