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Chapter-18 Ethical Aspects of Cesarean Section on Request

BOOK TITLE: Ethical Dilemmas in Perinatal Medicine

Author
1. Ludwig Hans
ISBN
9789380704050
DOI
10.5005/jp/books/11363_18
Edition
1/e
Publishing Year
2010
Pages
9
Author Affiliations
1. University of Basel, Switzerland, Wartenbergstr, Basel, Switzerland
Chapter keywords

Abstract

The height of a wide spread discussion about cesarean section on request was reached in the years 1977–2002. The following text tries to review the vivid debate, starting with the statement of FIGO’s “Committee for the Ethical Aspects of Human Reproduction” (1999) that no net benefit exists in performing a cesarean section for non-medical reasons and is therefore regarded to be not ethically justified. In the meanwhile the rate of cesarean section has further risen, mainly because cesarean section on request, and culminated in most Western countries and in the US at approximately 30 percent of all deliveries. Nevertheless, even at present we still do not have a prospective randomized study investigating the relevant endpoints of maternal and neonatal morbidity, including maternal morbidity in subsequent pregnancies, concerning cesarean section on demand carried out around the 39th week of pregnancy versus vaginal delivery at term. Such a study would face problems to be ethically justified. The principles in ethical considerations include non-maleficence and beneficence and those might be in contrast with the fundamental autonomy of the parturient choosing her mode of delivery. That choice—debate is far from being outdated, it is rather still repeated in each case. The article supports this debate by providing facts and the various points of discussion rose by the obstetricians as well as by the public. The final decision will continue to be made by the involved persons, guidelines at a rather weak position. But the ethics of the decision pro or contra cesarean section on request needs facts and the ongoing deliberation of the various, rather controversial aspects.

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