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Patient refusal of emergency cesarean delivery - A study of obstetricians' attitudes in Europe

Cuttini, Marina ; Habiba, Marwan ; Nilstun, Tore LU ; Donfrancesco, Silvia ; Garel, Micheline ; Arnaud, Catherine ; Bleker, Otto ; Da Fre, Monica ; Gomez, Manuel Marin and Heyl, Wolfgang , et al. (2006) In Obstetrics and Gynecology 108(5). p.1121-1129
Abstract
OBJECTIVE: To compare the attitudes of a large sample of obstetricians from eight European countries toward a competent woman's refusal to consent to an emergency cesarean delivery for acute fetal distress. METHODS: Obstetricians' attitudes in response to a hypothetical clinical case were surveyed through an anonymous, self-administered questionnaire. The sample included 1,530 obstetricians (response rate 77%) from 105 maternity units (response rate 70%) in eight countries: France, Germany, Italy, Luxembourg, Netherlands, Spain, Sweden and the United Kingdom. RESULTS: In every country, the majority of obstetricians would keep trying to persuade the woman, telling her that failure to perform cesarean delivery might result in the fetus... (More)
OBJECTIVE: To compare the attitudes of a large sample of obstetricians from eight European countries toward a competent woman's refusal to consent to an emergency cesarean delivery for acute fetal distress. METHODS: Obstetricians' attitudes in response to a hypothetical clinical case were surveyed through an anonymous, self-administered questionnaire. The sample included 1,530 obstetricians (response rate 77%) from 105 maternity units (response rate 70%) in eight countries: France, Germany, Italy, Luxembourg, Netherlands, Spain, Sweden and the United Kingdom. RESULTS: In every country, the majority of obstetricians would keep trying to persuade the woman, telling her that failure to perform cesarean delivery might result in the fetus surviving with disability, or even that her own life might be endangered. In Spain, France, Italy, and, to a lesser extent, Germany and Luxembourg, a consistent proportion of physicians would seek a court order to protect fetal welfare or avoid possible legal liability or both. In the United Kingdom, Sweden, and Netherlands, several respondents (59%, 41%, and 37%, respectively) would accept the woman's decision and assist vaginal delivery. Only a small minority (from 0 in the United Kingdom to 10% in France) would proceed with cesarean delivery without a court order. CONCLUSION: Case law arising from a few countries (United States, Canada, and the United Kingdom) and professional guidelines favoring women's autonomy have not solved the underlying ethical conflict, and in Europe acceptance of a woman's right to refuse cesarean delivery, at least in emergency situations, is not uniform. Differing attitudes between obstetricians from the eight countries may reflect diverse legal and ethical environments. (Less)
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organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Obstetrics and Gynecology
volume
108
issue
5
pages
1121 - 1129
publisher
Lippincott Williams & Wilkins
external identifiers
  • wos:000246769500011
  • scopus:33750502858
ISSN
1873-233X
DOI
10.1097/01.AOG.0000239123.10646.4c
language
English
LU publication?
yes
id
0b7cd658-5765-46dd-80ff-a14a253127b9 (old id 657684)
date added to LUP
2016-04-01 16:39:10
date last changed
2021-05-26 01:59:28
@article{0b7cd658-5765-46dd-80ff-a14a253127b9,
  abstract     = {OBJECTIVE: To compare the attitudes of a large sample of obstetricians from eight European countries toward a competent woman's refusal to consent to an emergency cesarean delivery for acute fetal distress. METHODS: Obstetricians' attitudes in response to a hypothetical clinical case were surveyed through an anonymous, self-administered questionnaire. The sample included 1,530 obstetricians (response rate 77%) from 105 maternity units (response rate 70%) in eight countries: France, Germany, Italy, Luxembourg, Netherlands, Spain, Sweden and the United Kingdom. RESULTS: In every country, the majority of obstetricians would keep trying to persuade the woman, telling her that failure to perform cesarean delivery might result in the fetus surviving with disability, or even that her own life might be endangered. In Spain, France, Italy, and, to a lesser extent, Germany and Luxembourg, a consistent proportion of physicians would seek a court order to protect fetal welfare or avoid possible legal liability or both. In the United Kingdom, Sweden, and Netherlands, several respondents (59%, 41%, and 37%, respectively) would accept the woman's decision and assist vaginal delivery. Only a small minority (from 0 in the United Kingdom to 10% in France) would proceed with cesarean delivery without a court order. CONCLUSION: Case law arising from a few countries (United States, Canada, and the United Kingdom) and professional guidelines favoring women's autonomy have not solved the underlying ethical conflict, and in Europe acceptance of a woman's right to refuse cesarean delivery, at least in emergency situations, is not uniform. Differing attitudes between obstetricians from the eight countries may reflect diverse legal and ethical environments.},
  author       = {Cuttini, Marina and Habiba, Marwan and Nilstun, Tore and Donfrancesco, Silvia and Garel, Micheline and Arnaud, Catherine and Bleker, Otto and Da Fre, Monica and Gomez, Manuel Marin and Heyl, Wolfgang and Marsal, Karel and Saracci, Rodolfo},
  issn         = {1873-233X},
  language     = {eng},
  number       = {5},
  pages        = {1121--1129},
  publisher    = {Lippincott Williams & Wilkins},
  series       = {Obstetrics and Gynecology},
  title        = {Patient refusal of emergency cesarean delivery - A study of obstetricians' attitudes in Europe},
  url          = {http://dx.doi.org/10.1097/01.AOG.0000239123.10646.4c},
  doi          = {10.1097/01.AOG.0000239123.10646.4c},
  volume       = {108},
  year         = {2006},
}