Education And Debate

Commentary: Bad medicine and bad law

BMJ 1997; 314 doi: (Published 19 April 1997) Cite this as: BMJ 1997;314:1184
  1. Susan Bewley, director of obstetricsa
  1. a Guy's and St Thomas's Hospitals Trust, St Thomas's Hospital, London SE1 7EH


    Pregnancy and mental illness frighten doctors, and, for different reasons, both sets of patients are at risk of losing basic human rights. Law exists to protect patients from well intentioned but overenthusiastic doctors. We override long established law on consent, the legal status of fetuses, and the enforced treatment for mental conditions at our peril. The recent spate of cases of caesarean sections poses a serious threat to the therapeutic relationship and takes place against a background already coloured by accusations of unnecessary intervention by a male dominated profession. There is no trusting relationship if an obstetrician says: “I recommend a particular course of action (but I can force it on you if you do not agree).”

    Obstetricians are passionate advocates of fetal health and wellbeing, and we have worked well for a long time with heavy duty persuasion as our most powerful weapon. Standing back is terribly painful, and the inability to perform caesarean sections without consent means that we will occasionally care for …

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