Patient refusal of emergency cesarean delivery: a study of obstetricians' attitudes in Europe.
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.


CONCLUSIONS
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.


METHODS
III.
Cuttini
Marina
M
Unit of Epidemiology, Ospedale Pediatrico Bambino Gesù, Roma, Italy. cuttini@opbg.net
Habiba
Marwan
M
Nilstun
Tore
T
Donfrancesco
Silvia
S
Garel
Micheline
M
Arnaud
Catherine
C
Bleker
Otto
O
Da Frè
Monica
M
Gomez
Manuel Marin
MM
Heyl
Wolfgang
W
Marsal
Karel
K
Saracci
Rodolfo
R
D000328:Adult; D001291:Attitude of Health Personnel; D002585:Cesarean Section / Q000941:ethics / Q000523:psychology*; D003625:Data Collection; D005060:Europe; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009774:Obstetrics; D010820:Physicians / Q000523:psychology*; D011247:Pregnancy; D016312:Treatment Refusal / Q000941:ethics / Q000523:psychology*