title: An ethically justified algorithm for offering, recommending, and performing cesarean delivery and its application in managed care practice.
abstract: When cesarean delivery is substantively supported and vaginal delivery is not supported in beneficence-based clinical judgment, the physician should offer and recommend only cesarean delivery. When both cesarean and vaginal delivery are substantively supported in beneficence-based clinical judgment, the physician should offer both, discuss any controversy, and make a recommendation. When cesarean delivery is substantively supported and vaginal delivery is more substantively supported in beneficence-based clinical judgment, the physician should offer both and recommend vaginal delivery. If cesarean delivery is not supported and vaginal delivery is substantively supported in beneficence-based clinical judgment, the physician should offer only vaginal delivery. When cesarean delivery is requested and well supported solely in autonomy-based clinical judgment, the physician should repeat the recommendation for vaginal delivery and either perform cesarean delivery or make a referral. Physicians may use this algorithm in negotiating managed care contracts.
authors.affiliation: Department of Obstetrics and Gynecology, New York Hospital-Cornell Medical Center, New York, USA.
authors.forename: F A
authors.initials: FA
authors.lastname: Chervenak
authors.forename: L B
authors.initials: LB
authors.lastname: McCullough
mesh_terms: D000465:Algorithms; D026686:Beneficence; D002585:Cesarean Section; D032982:Contracts; D030881:Disclosure; D004992:Ethics, Medical; D005260:Female; D006801:Humans; D008329:Managed Care Programs; D026706:Paternalism; D026684:Personal Autonomy; D011247:Pregnancy; D037841:Pregnant People; D018570:Risk Assessment