title: Fear of litigation and cesarean section rates.
abstract: Both the rates of cesarean section and the rates and payouts from obstetrical malpractice suits have risen in past decades, albeit not always in tandem. A great deal of evidence suggests that physicians practice defensive medicine, and many obstetricians acknowledge that a more liberal recourse to cesarean section is one such behavior in which they sometimes engage. However the degree to which fear of litigation actually is a contributor to, or perhaps even a driver of, the rising cesarean section rate is not as clearly known. In this article I will discuss the research that has been performed that attempts to epidemiologically assess the link between lawsuits, malpractice premiums and cesarean section rates. I will also consider factors beyond dollars and cents (e.g., cognitive biases, changing risk tolerance of doctors and patients) that may lie at the base of the relationship. Finally I will offer a brief discussion of how professional ethics should inform the actions that physicians take in these difficult circumstances.
authors.affiliation: Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, NY 11219, USA. hminkoff@maimonidesmed.org
authors.forename: Howard
authors.initials: H
authors.lastname: Minkoff
mesh_terms: D002585:Cesarean Section / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data; D003675:Defensive Medicine; D005260:Female; D006801:Humans; D008318:Malpractice / Q000331:legislation & jurisprudence*; D009774:Obstetrics / Q000331:legislation & jurisprudence*; D010820:Physicians / Q000331:legislation & jurisprudence; D011247:Pregnancy; D012306:Risk