A few recent posts by Mom's Tinfoil Hat--Reply turned post, three way mirror style and
Reply turned post, tired-of-pushing style--got me thinking about the ethics of refusing to do a non-medically indicated cesarean section. If a woman requests to have a c-section with no medical reason, are physicians justified in refusing to perform one? Does refusal or promotion of elective cesarean section (ECS) have ethical implications for other birth choices, such as VBAC or homebirth? Is ECS a "choice" that is an essential part of women's reproductive rights? If a physician defends a woman's right to choose ECS, should he/she also be obliged to defend her right to choose homebirth, waterbirth, etc? Is it ethically/morally justifiable to refuse a woman an ECS but to argue that VBACs should not be banned?
Here's how I see the issue: Refusing to perform a non-medically indicated cesarean is ethically justifiable. Refusing to allow VBAC is not. What's the difference between the two situations?
1) Elective cesarean section is a medical procedure that cannot happen without the physicians and staff to perform it. On the other hand, a vaginal birth after cesarean is not a medical procedure, but rather the spontaneous and inevitable conclusion of pregnancy. It will occur whether or not there is someone doing something.
2) As I understand it, patients have the legal right to informed consent, which includes the right to decline/refuse medical treatment and to bodily autonomy* (provided they are in a state to make competent decisions). Patients do not have the legal right to demand medically unnecessary procedures; they only have the right to decline procedures that are offered/indicated. Refusing to perform an ECS does not violate a patient's right to informed consent and refusal. If a physician feels that there is no good reason to perform a cesarean section (or any other medical procedure), they can refuse to do it and/or refer the patient to another care provider. However, banning VBACs does violate a woman's legal rights, in that it does not allow the woman to refuse a repeat cesarean section.
What are your thoughts on this issue?
* For additional reading on this topic, see:
The Right to Refuse Treatment: Ethical Considerations for the Competent Patient in the Canadian Medical Association Journal
The NHS' explanantion of the right to refuse treatment
Informed Consent and the Right to Refuse Treatment by Valerie Goodwin Larcombe, Esq.