Letters

Elective caesarean section on request

BMJ 1999; 318 doi: https://doi.org/10.1136/bmj.318.7176.120 (Published 09 January 1999) Cite this as: BMJ 1999;318:120

This article has a correction. Please see:

Patients do not have right to impose their wishes at all cost

  1. Paquita de Zulueta, Clinical lecturer
  1. Department of General Practice and Primary Care, Imperial College School of Medicine, London W2 1PG
  2. Queen Charlotte's and Chelsea Hospital, London W6 0XG
  3. St James's University Hospital, Leeds LS9 7TF
  4. Hull Maternity Hospital, Hull HU9 5LX
  5. Leiden University Medical Centre, Leiden, Netherlands
  6. Gynaecology Cancer Research Unit, St Bartholomew's Hospital, London EC1A 7BE
  7. King George Hospital, Ilford, Essex IG3 8YB

    EDITOR—Paterson-Brown seems to assume that an autonomous patient has an unconditional right to have her wishes fulfilled.1 The (negative) right to decline treatment needs to be distinguished from the supposed (positive) right to demand it. In English law, the principle of autonomy allows, for example, competent people the right to refuse life saving treatment, and doctors have a correlative duty to respect this right.2 A dying patient, however, does not have the right to impose a duty on a healthcare professional to end his or her life.

    With respect to medical and surgical interventions, the law is also clear. A patient, however competent, cannot invariably impose his or her demands and force a practitioner to act in a way which he or she believes to be contrary to the patient's best interests. This prerogative would be viewed by the courts as “an abuse of power as directly or indirectly requiring the practitioner to act contrary to the fundamental duty which he owes to his patient” (per Lord Donaldson).3

    Healthcare professionals could not preserve their professional integrity, self respect, or credibility if they were to act as mere instruments to the “foolish” or “irrational” demands of patients, particularly if this ran contrary to good medical practice or violated their deeply held values.4 Decision making should be a collaborative enterprise based on mutual respect with the shared goal of the good of the patient.

    Distributive justice also deserves consideration here. If patients demand expensive treatments such as caesarean sections, in circumstances for which there is little or no evidence of benefit—and, indeed, there may be evidence of harm—the costs should be considered.

    The profession and the public, in the interest of patient welfare, should consider setting limits to personal autonomy and to professional self effacement.

    References

    All types of anaesthesia carry risks

    1. Bernard Norman, Specialist registrar in anaesthesia.,
    2. John A Crowhurst, Reader in obstetric anaesthesia.,
    3. Felicity Plaat, Consultant obstetric anaesthetist.
    1. Department of General Practice and Primary Care, Imperial College School of Medicine, London W2 1PG
    2. Queen Charlotte's and Chelsea Hospital, London W6 0XG
    3. St James's University Hospital, Leeds LS9 7TF
    4. Hull Maternity Hospital, Hull HU9 5LX
    5. Leiden University Medical Centre, Leiden, Netherlands
    6. Gynaecology Cancer Research Unit, St Bartholomew's Hospital, London EC1A 7BE
    7. King George Hospital, Ilford, Essex IG3 8YB

      EDITOR—We agree with …

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