Patient refusal of emergency cesarean delivery

A study of obstetricians' attitudes in Europe

Marina Cuttini, Marwan Habiba, Tore Nilstun, Silvia Donfrancesco, Micheline Garel, Catherine Arnaud, Otto Bleker, Monica Da Frè, Manuel Marin Gomez, Wolfgang Heyl, Karel Marsal, Rodolfo Saracci

Research output: Contribution to journalArticle

23 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)1121-1129
Number of pages9
JournalObstetrics and Gynecology
Volume108
Issue number5
DOIs
Publication statusPublished - Nov 2006

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Emergencies
Luxembourg
France
Sweden
Netherlands
Spain
Italy
Germany
Legal Liability
Fetal Distress
Women's Rights
Canada
Fetus
Guidelines
Physicians
United Kingdom
Surveys and Questionnaires

ASJC Scopus subject areas

  • Obstetrics and Gynaecology

Cite this

Patient refusal of emergency cesarean delivery : A study of obstetricians' attitudes in Europe. / Cuttini, Marina; Habiba, Marwan; Nilstun, Tore; Donfrancesco, Silvia; Garel, Micheline; Arnaud, Catherine; Bleker, Otto; Da Frè, Monica; Gomez, Manuel Marin; Heyl, Wolfgang; Marsal, Karel; Saracci, Rodolfo.

In: Obstetrics and Gynecology, Vol. 108, No. 5, 11.2006, p. 1121-1129.

Research output: Contribution to journalArticle

Cuttini, M, Habiba, M, Nilstun, T, Donfrancesco, S, Garel, M, Arnaud, C, Bleker, O, Da Frè, M, Gomez, MM, Heyl, W, Marsal, K & Saracci, R 2006, 'Patient refusal of emergency cesarean delivery: A study of obstetricians' attitudes in Europe', Obstetrics and Gynecology, vol. 108, no. 5, pp. 1121-1129. https://doi.org/10.1097/01.AOG.0000239123.10646.4c
Cuttini, Marina ; Habiba, Marwan ; Nilstun, Tore ; Donfrancesco, Silvia ; Garel, Micheline ; Arnaud, Catherine ; Bleker, Otto ; Da Frè, Monica ; Gomez, Manuel Marin ; Heyl, Wolfgang ; Marsal, Karel ; Saracci, Rodolfo. / Patient refusal of emergency cesarean delivery : A study of obstetricians' attitudes in Europe. In: Obstetrics and Gynecology. 2006 ; Vol. 108, No. 5. pp. 1121-1129.
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AU - Arnaud, Catherine

AU - Bleker, Otto

AU - Da Frè, Monica

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N2 - 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.

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