The professional responsibility model of obstetric ethics and caesarean delivery

• Frank A. Chervenak
• L.B. McCullough

Abstract

This article provides an account of the professio nal responsibility model of obstetric ethics and identifies its implications for two major topics: patient-choice caesarean delivery and trial of labor after caesarean delivery (TOLAC). The professional responsibility model of obstetric ethics is based on the ethical concept of medicine as a profession and the ethical principles of beneficence and respect for autonomy. The obstetrician has beneficence-based and autonomy-based obligations to the pregnant woman and beneficence-based obligations to the fetus when it is a patient. Because the viable fetus is a patient, the ethics of cesarean delivery requires balancing of obligations the pregnant and fetal patient. The implication of the professional responsibility model for patient-choice caesarean delivery is that the obstetrician should respond to such requests with a recommendation against nonindicated caesarean delivery and for vaginal delivery. These recommendations should be explained and discussed in the informed consent process. It is ethically permissible to implement an informed, reflective decision for nonindicated caesarean delivery. The implication for TOLAC is that, in settings properly equipped and staffed, the obstetrician should offer both TOLAC and planned caesarean delivery to women with one previous low transverse incision. The obstetrician should recommend against TOLAC for women with a previous classical incision.

Original article is published in Best Practice & Research Clinical Obstetrics & Gynaecology.

Editorial office of journal «Obstetrics and gynecology: news, views, education» No. 1, 2014 expresses gratitude to Elsevier publishing company for possibility of republication.

Reference to article: Chervenak F.A., McCullough L.B. The professional responsibility model of obstetric ethics and caesarean delivery // Best Pract. Res. Clin. Obstet. Gynaecol. – 2013. – Vol. 27 (2). – P. 153–164.

Keywords:beneficence, patient-choice caesarean delivery, professional responsibility model of obstetric ethics, respect for autonomy, trial of labor after caesarean delivery