When confronted by a
complex situation in which there are conflicting values and rights, getting
the most people involved is the best approach to reduce risk and to come
up with the best, most defensible answer under the current circumstances.
The obstetrician should employ whatever departmental or hospital
resources are available. A standing ethics committee or an ad hoc committee
to deal with such complex situations is often available and will minimize
the ultimate medicolegal problems that can ensue when bad
outcomes seem likely. The obstetrician must further recognize that he or
she has two patients, but that it is not clear, nor is it legislated, whose interests
take priority. However, general ethical opinion is that the mother generally
should come first. Most court-ordered cesarean sections have been
performed on patients who were estranged from the medical system, and
this sets a very bad precedent for further state intervention in doctorpatient
relationships and maternal rights. Child abuse statutes do not at
this point require a court order to force a cesarean section even for a
healthy fetus, and a court order would almost never be appropriate.
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