Patient choice cesarean delivery: ethical issues.
OBJECTIVE
We have recently identified three salient questions within the patient choice cesarean delivery controversy. First, is performing cesarean delivery on maternal request consistent with good professional medial practice? Second, how should physicians respond to or counsel patients who request patient choice cesarean delivery? Third, should patient choice cesarean delivery be routinely offered to all pregnant women?


RESULTS
In a well informed patient, performing a cesarean delivery on maternal request is medically and ethically acceptable. Physicians, as patient advocates and promoters of overall health and welfare of their patients, however, should, in the absence of an accepted medical indication, recommend against medically unindicated cesarean delivery. While we believe that current evidence supports a physician's decision to accede to an informed patient's request for such a delivery, it does not follow that obstetricians should routinely offer elective cesareans to all patients.


CONCLUSIONS
When a patient makes a request for an elective cesarean delivery, obstetricians, in their capacity as patient advocate, must help guide their patient through the labyrinth of detailed medical information toward a decision that respects both the patient's autonomy and the physician's obligation to optimize the health of both the mother and the newborn.
Kalish
Robin B
RB
Weill Cornell Medical College, New York, New York 10065, USA. robinkal@aol.com
McCullough
Laurrence B
LB
Chervenak
Frank A
FA
D002585:Cesarean Section / Q000941:ethics*; D002755:Choice Behavior; D017558:Elective Surgical Procedures / Q000941:ethics; D026690:Ethics, Clinical; D005260:Female; D006801:Humans; D007258:Informed Consent; D010344:Patient Advocacy / Q000941:ethics*; D010358:Patient Participation; D028701:Patient Rights / Q000941:ethics; D010817:Physician-Patient Relations; D011247:Pregnancy; D011364:Professional Practice / Q000941:ethics*