Court-ordered Cesarean Section Research Articles

Obstetricians, Health Attorneys, and Court-Ordered Cesarean Sections

Despite court rulings suggesting that court-ordered cesarean sections should rarely be undertaken, they are performed. Our objective was to determine those characteristics of providers and patients that make their use more likely. A convenience sample of obstetricians attending the annual meeting of the American College of Obstetricians and Gynecologists (n=229) and lawyers attending the annual meeting of the American Health Lawyers Association (n=126) read a vignette describing a woman who refused a cesarean section after being told that her fetus would die unless she received the operation. Several different scenarios were then described (e.g., the mother refused on religious grounds). For each scenario, participants were asked to rate the likelihood that they would support a court-ordered cesarean section. Participants then described their own characteristics. Respondents were more likely to support a court order if the woman was described as a being "high on drugs" (p<.001). Respondents were significantly less likely to use a court order (p<.01) if the woman was described as a lawyer, the child had Down syndrome, the husband agreed with her decision, the mother refused on religious grounds, or the operation was associated with a 10-fold increased risk to the mother's life. People who described themselves as more religious, Republican, or "pro-life" were significantly more likely to utilize court orders in several scenarios. In an ordinal regression model, the degree of pro-life was the only variable consistently associated with obtaining a court order for the healthy mother-healthy child. The perceived likelihood of performing a court-ordered cesarean section varies with characteristics of the patient and the provider.

The Rights of &amp;quot;Unborn Children&amp;quot; and the Value of Pregnant Women

A quarter century after International Year of Child, we now seem to be in era of Child. Partly this because of medical advances: highly refined imaging techniques have made fetus more visually accessible to parents. In good measure, however, new era a product of political shifts. In 2004, President Bush signed into law Unborn Victims of Violence Act, which makes it a separate federal offense to bring about death or bodily injury of a in utero while committing certain crimes, and recognizes everything from a zygote to a fetus as an independent victim with legal rights distinct from woman who has been harmed. In 2002, Department of Health and Human Services adopted new regulations expanding definition of child in State Children's Health Insurance Program so that a State may elect to make individuals in period between conception and birth eligible for coverage. Finally, Senator Brownback and thirty-one cosponsors have proposed Unborn Child Pain Awareness Act, a scientifically dubious piece of legislation that would require physicians performing exceedingly rare abortions after twenty weeks to inform pregnant women of the option of choosing to have anesthesia or other pain-reducing drug or drugs administered directly to pain-capable unborn child. The legislative focus on unborn aimed at women who choose abortion, but it may also have adverse consequences for women who choose not to have an abortion, and it challenges a central tenet of human rights--namely, that no person can be required to submit to state enforced surgery for benefit of another. The historical context of rights legislation should make most fervent proponents of rights--pregnant women--wary. Often, in past, expansions of rights have been purchased through diminution of pregnant women's rights. The to from environmental toxins cost pregnant women right to good jobs: for nearly ten years before U.S. Supreme Court ruled against such polices in 1991, companies used fetal protection policies as a basis for prohibiting fertile women from taking high-paying blue collar jobs that might expose them to lead. The to health and life has cost women their bodily integrity (women have been forced to undergo cesarean sections or blood transfusion), their liberty (women have been imprisoned for risking harm to a fetus through alcohol or drug use), and in some cases their lives (a court-ordered cesarean section probably accelerated death in 1987 of Angela Carder, who had a recurrance of bone cancer that had metastasized to her lung). The not to be exposed to pharmaceutical agents has cost pregnant women their right to participate in drug trials that held out their only hope of cure from lethal illnesses. The vehicle for these infringements on pregnant women's rights has been third parties' assertions that they, rather than mother, have authority to speak for fetus in securing these newly defined rights. For example, employers have argued for right to speak for fetus in determining when a work environment inappropriate for fetus. In mandating cesarean section, courts have apparently concluded that judiciary better positioned to speak for fetus and that a competent but dying mother's wishes to refuse surgery are no longer worthy of consideration. Most recently, a state's attorney has taken up cudgel for fetus by charging a woman with murder for her refusal to consent to a cesarean section. It within context of these attempts to wrest right to speak for fetus from mothers that legislation that will expand rights of fetus--such as Unborn Victims of Violence Act--must be considered. The act makes injury or death of a fetus during commission of a crime a federal offense, punishment for which is same as punishment . …

Can cesarean section be performed without the woman's consent?

Occasionally an obstetrician can experience conflicts between the mother and her fetus. In a situation where the life of the fetus is in danger religious cultural or other convictions may cause the mother to refuse the physician’s recommendations for delivery. When there is a medical indication to perform cesarean section but the mother refuses has the obstetrician then a right to perform a cesarean section to save the fetus from possible death or serious injury? In 1987 The Norwegian Directorate of Health made a statement on cesarean section without consent but later new legislation on patient rights has been introduced. In Norway no scientific medical articles have been published on this topic and no cases have yet been brought to court. Cases of court-ordered cesarean section have been reported from the UK and the USA. In this report we discuss some of the ethical moral and legal aspects of forced cesarean sections. (authors)

Can cesarean section be performed without the woman's consent?

Occasionally, an obstetrician can experience conflicts between the mother and her fetus. In a situation where the life of the fetus is in danger, religious, cultural, or other convictions may cause the mother to refuse the physician's recommendations for delivery. When there is a medical indication to perform cesarean section, but the mother refuses, has the obstetrician then a right to perform a cesarean section to save the fetus from possible death or serious injury? In 1987, The Norwegian Directorate of Health made a statement on cesarean section without consent, but later, new legislation on patient rights has been introduced. In Norway, no scientific medical articles have been published on this topic, and no cases have yet been brought to court. Cases of court-ordered cesarean section have been reported from the UK and the USA. In this report, we discuss some of the ethical, moral, and legal aspects of forced cesarean sections.

Forensic Implications and Medical-Legal Dilemmas of Maternal Versus Fetal Rights

The purpose of this paper is to review the issue of fetal rights from primarily a legal perspective, with consideration of morals and professional ethics. The practice of medicine is fraught with numerous bioethical dilemmas. These dilemmas often leave the physician wondering if he has made the correct decision. A physician's morals and professional ethics may influence his or her decision in resolving bioethical dilemmas. The case example is a 34-year-old female with a 41-week intra-uterine pregnancy. The mother was refusing induction of labor. Without the labor induction, the fetus may die. Despite this risk, the mother desired to pursue a vaginal delivery. The AMA's ethics state that a competent, pregnant mother's wishes should prevail and the court should not be involved unless there are unusual circumstances. The mother in the case example was competent and informed consent was provided. Case law does not specifically address the dilemma of the case example. However, there is case law regarding court-ordered cesarean sections which reveals different opinions. The difference in court opinion encompasses the relative degree of weight given to the fetus's right to be born healthy and alive versus the mother's privacy rights. Some courts describe this "balancing test," whereas others state that the mother's privacy rights prevail unless there are exceptional circumstances, which will be extremely rare. The fetus has acquired rights in other areas of the law; for example, abolishment of the intra-family immunity doctrine and the definition of murder in most states. In considering the legal arena of fetal versus maternal rights, a decision tree is presented to assist physicians in assessing cases of a pregnant mother refusing medical treatment. There is no precise demarcation in assessing fetal and maternal rights. The greater the degree of fetal viability, the greater degree of fetal rights. Consideration must also be given to the relative degree of invasiveness to the mother for the proposed procedure; the more invasive, the greater degree of maternal rights. Each case must be evaluated on an individual basis and the decision tree can assist a clinician with this process.

Maternal–Fetal Conflict: Court-Ordered Cesarean Section

Advances in prenatal care have created areas of conflict between the pregnant woman and her fetus. Court orders mandating cesarean section have denied to pregnant women rights that are accorded to all other competent adults in the United States. The caregiver-patient relationship can become adversarial in such situations. Nurses participating in the decision-making process when judicial involvement is being considered must be informed about the issues.

Decision Making with Pregnant Patients: A Policy Born of Experience

One hospital has developed an institutional policy to guide decision making between physicians and pregnant patients. Read the policy and a description of how it was developed by the ethics committee at the George Washington University Hospital.

Reproductive Rights and the Medical Care System: A Plea for Rational Health Policy

Recently, there have been many challenges to women's reproductive rights and freedoms: court-ordered cesarean sections; criminal cases against women for prenatal child abuse; and attempts to limit the practice of mid-wifery, home birth, and the operation of alternative birth centers. In these cases, medicine has been complicit or proactive in attempts to control the behavior or health care options of pregnant women. We discuss medicine's role as an agent of social control, the medical reconstruction of problems that are social in nature, and the need for a more coherent policy framework to guide physician practices.

Recent developments in health law relevant to health care providers.

Because health law is changing continually, clinicians must be updated periodically. This article discusses two significant legal developments: the defeat of court-ordered cesarean sections and the new Patient Self-Determination Act. A decision reached by the Court of Appeals for the District of Columbia asserted that medical decisions on behalf of a woman and her fetus should be made by the pregnant woman if she is conscious and alert. Although this decision does not supply all the answers, it reiterates judicial support for the primacy of a woman's rights when her welfare is endangered by a procedure designed to safeguard a fetus. The Patient Self-Determination Act, effective December 1991, requires health care providers at hospitals and other sites to supply all adult patients with written information advising them of their rights, to explain the provider's policy for implementing those rights and to document any advance directives supplied by patients.

Maternal-Fetal Conflict: A Study of Physician Concerns in Court-Ordered Cesarean Sections

Previous articleNext article No AccessMaternal-Fetal Conflict: A Study of Physician Concerns in Court-Ordered Cesarean SectionsThomas E. Elkins, Douglas Brown, Mel Barclay, and H. Frank AndersenThomas E. ElkinsUniversity of Michigan Medical Center, Ann Arbor Search for more articles by this author , Douglas BrownHarding University Graduate School of Religion, Memphis Search for more articles by this author , Mel BarclayUniversity of Michigan Medical Center, Ann Arbor Search for more articles by this author , and H. Frank AndersenUniversity of Michigan Medical Center, Ann Arbor Search for more articles by this author PDFPDF PLUS Add to favoritesDownload CitationTrack CitationsPermissionsReprints Share onFacebookTwitterLinkedInRedditEmail SectionsMoreDetailsFiguresReferencesCited by Volume 1, Number 4Winter 1990 Published on behalf of the MacLean Center for Clinical Medical Ethics Article DOIhttps://doi.org/10.1086/JCE199001417 Views: 1Total views on this site © 1990 The University of Chicago. All rights reserved.PDF download Crossref reports no articles citing this article.

In Re A.C.—An affirmation of ACOG committee opinion number 55: Maternal-fetal conflict

I n April 1990, the District of Columbia Court of Appeals issued its opinion In Re A.C., the much-publicized case involving a court-ordered cesarean section performed on a dying woman June 1987.1 The court's decision holding that in virtually all cases the question of what is to be done is to be decided by the pat ient-the pregnant w o m a n o n behalf of herself and the fetus, is a precedent-setting reaffirmation of a pregnant woman's autonomy making her own health care decisions. Although there is rarely a conflict of interest between a recommended medical treatment thought to be beneficial to a fetus and the pregnant woman's choice concerning medical care, recent cases concerning court-ordered cesarean sections and drug use by pregnant women have brought to public attention the tension that can exist between a woman's right to determine her health care treatment and concerns for the well-being of the fetus. As the representative organization of board-certified obstetricians and gynecologists, the American College of Obstetricians and Gynecologists (ACOG), through its Committee on Ethics, was the first medical specialty society to issue a public statement on this issue. Committee Opinion Number 55, Patient Choice: Maternal-Fetal Conflict, of October 1987, is a document that supports a woman's autonomy making health care decisions. As such, it provides important guidance for many troublesome medical/legal situations. On occasion, physicians and hospital administrators have sought court orders to require a pregnant woman to undergo a certain medical or surgical procedure to which she will not consent, on the grounds that it is necessary to protect the health of the fetus. 2-4 Of the numerous documented instances which a court order has been sought to require a woman to undergo an emergency cesarean delivery, only one case has been described the literature which the judge refused to grant the order. 4 Concern about the inappropriateness of the courtroom as a forum for medical decision making as well as concern about the deleterious effect judicial intervention has on a woman's autonomy and on the physician-patient relationship prompted the ACOG Ethics Committee document. It rejects the © 1990 by The Jacobs Institute of Women's Health 1049-3867/90/$3.50

The case for a middle ground

M aternal-fetal conflict is a relatively new and mysterious phrase that is being applied to more and more medical-ethical-legal dilemmas in obstetric care. It describes such situations as legally mandated treatment programs for alcohol abuse in pregnancy, punitive legal action for cocaine abuse in pregnancy, decisions to perform (at significant maternal risk) in utero surgery for fetal anomalies, and even court-ordered cesarean sections to benefit the viable fetus. Not unrelated are the numerous issues surrounding abortion and prenatal genetic counseling. Rather than the traditional (mis)conception of a passive woman willing to give birth to a healthy child at any cost, the contemporary American woman occasionally resists health care that appears overly restrictive, intrusive, invasive, or threatening to her when fetal well-being is in question. Such situations seem to amplify an increasingly common conflict between mother and fetus. A brief look at the court-ordered cesarean section issue highlights these situations and gives a basis for the emotion and distress they foster. 1. Prominent ethical and legal concerns about privacy, bodily integrity, and autonomy are held to be near absolutes in a free society. 1 In health care, this has been translated into a strong doctrine of informed consent and an emphasis on each competent person's right to refuse medical treatment. 2 An extreme autonomy stance places the physician in the role of an obstetric technician whose only task is to assess patient competency and whose duty is to perform the competent patient's wishes or refer her to someone who will. 2. Retrospective reviews have revealed errors in diagnostic accuracy that have led to forced cesarean section. 3 Some claim that in utero assessment is simply not exact enough ever to allow using such parameters to force treatment against someone's will. 3. The dominant place of the mother in comparison with the fetus in obstetric decision making is also championed by many, even at near-term gestation. Rights theorists give little philosophic justification to any concept of fetal rights. 4 The most extreme position sees only one patient (the mother) to whom the fetus belongs as property, s 4. Finally, arguments are made that incorporate broader concerns than simply a single situation. Authors have tried to make settings where forced cesarean sections were considered analogous to other settings of interdependence (such as a sibling's need for a bone transplant) in which no court has ever forced organ donation or surgery on one person for the benefit of an© 1990 by The Jacobs Institute of Women's Health 1049-3867/90/$3.50

Court-Ordered Cesarean Sections Receive Judicial Defeat

In a quiet, often unnoticed, but consistent manner, a number of trial-court judges in at least 11 states across the country have ordered that a pregnant woman must submit to a cesarean section to deliver a viable fetus against the known and clearly expressed will of the woman. This legal intervention has virtually always been brought about by the same physicians who were caring for the woman during her pregnancy. As one legal commentator has observed, "In most cases that have been brought, doctors have prevailed easily."1 In what is still the only nationwide survey of court orders sought by . . .

Court-ordered cesarean section: An analysis of ethical concerns in compelling cases

Two previously unreported cases are presented in which court-ordered cesarean sections were considered appropriate by physicians. An analysis of the factors that compel physicians to deem court-ordered intervention appropriate is presented. When the significance of a third-trimester fetal death or a lifetime physical or mental disability is balanced against the demand to uphold maternal autonomy at all costs, the recognized ethical principles of beneficence, nonmaleficence, justice, obstetric contract keeping, and acting in the patients' best interests combine, in rare situations, to override concerns for individual maternal autonomy and justify court-ordered intervention.