What is it about?
When a pregnant woman is offered, or advised to have a Caesarean section, it is often assumed that she will follow this advice, in the interests of her foetus. This is in part because of societal pressures for a 'mother' to behave in particular ways. putting her interests second to those of her foetus. It is also because the standard approach to antenatal care encourages both the woman and her medical care-givers to see the foetus as a patient in their own right. This paper explores how these pressures make it difficult for a woman to choose not to undergo a Caesarean that has been advised on medical grounds, even where she has substantive reasons for doing so. It discusses the way in which medical professionals and systems can support women's decision-making in pregnancy and birth. It also considers, but rejects, arguments that women's choices can be overridden where the life of their foetus is in danger. This article is written from a UK perspective but is likely to hold true for at least some other Western societies and medical systems, and the underlying principles of why woman's autonomy must be respected are universal.
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Why is it important?
Fundamentally, this paper is about why you can't stick a knife in a living person without their consent*. This holds true even when that living person is pregnant. Reports of enforced Caesarean over the last few years have sparked media debate about the extent to the foetus's interests overrule those of the mother, with the woman's role often seemingly diminishing to that of 'carrier' with interests that are subordinated to her duties towards her foetus. This paper is important because it explains the huge range of factors which impact on, and tend to limit, a woman's ability to make an autonomous decision about whether to have major surgery. It proposes an approach to support a woman's decision-making, ensuring that she is able to make a decision that is right for her (as an individual and as a mother), without being forced into unwanted surgery by societal and medical pressures. *With thanks to the colleague who used a similar form of words to describe this article: you put it very well.
Perspectives
This article was sparked by the media coverage of an Italian woman who was detained under the Mental Health Act whilst heavily pregnant and subsequently underwent a Caesarean section authorised by a court order on 'best interest' grounds (see e.g. http://www.familylawweek.co.uk/site.aspx?i=ed121964). This case, whilst being complicated by capacity issues, started me thinking of the expectations placed on a woman to acquiesce to 'standard' medical care and the difficulties inherent in bringing in values beyond those considered in clinical decision making. In writing this article, I have been struck by the differences in expectations placed on mothers compared to fathers, and by the lack of regard in many parts of the literature to the importance to the woman herself of a positive outcome for her and the foetus to pregnancy and birth.
Mrs Rebecca Brione
St. Mary's University, Twickenham
Read the Original
This page is a summary of: To What Extent Does or Should a Woman's Autonomy Overrule the Interests of Her Baby? A Study of Autonomy-related Issues in the Context of Caesarean Section, The New Bioethics, May 2015, Taylor & Francis,
DOI: 10.1179/2050287715z.00000000058.
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