The parturient woman: can there be room for more than 'one person with full and equal rights inside a single human skin'?

Abstract

The aim of the paper is to raise awareness around the legal and ethical issues involved in the enforcement of caesarean sections on non-consenting women. The paper considers the competing rights of mother and foetus in situations where a mother's wishes may result in harm or death to the foetus. In this light of various court decisions about enforcing caesarean sections, the paper examines the pertinent legal and ethical issues, recognising that health professionals need to operate within an explicit legal and ethical framework. Content. The arguments about a woman's right to autonomous decision-making and a foetus' absolute right to life are examined with the focus throughout being on the legal framework. The need for health professionals to work within this as well as to avoid the temptation to base individual clinical decisions or professional behaviour on subjective moral judgements is emphasized. The attitudes of the judiciary are considered along with recent legal developments. There is an analysis of the way in which established legal principle is sometimes circumvented to override a woman's right to autonomy. The part played by lawyers and health professionals in denying a woman's competence to consent in order to achieve an outcome of which they approve is critically appraised. The basis for the decisions in these cases is deconstructed, along with a discussion of the role of health professionals in contributing to the dilemmas highlighted. It is essential that nurses or midwives caring for pregnant women have a full understanding of the legal and ethical issues surrounding this complicated and emotive area and where they, as health professionals, fit within this. The subject matter is also a useful arena for debating such ethical and legal issues as capacity and competence to consent as well as the extent of the right of any patient to full autonomy.