Offering C-section 'on demand' can be ethical: ACOG: committee opinion: doctors 'ethically justified' in performing procedure if certain conditions are met.(News)

A physician who believes elective cesarean delivery is in the best interests of the mother and her fetus is ethically justified in performing the procedure, according to a committee opinion issued last month by the American College of Obstetricians and Gynecologists.

"This is critically important. Now we have an ACOG opinion saying it is ethical to perform an elective cesarean," Dr. "W. Benson Harer, a past president of the college, told this newspaper.

The opinion, "Surgery and Patient Choice: The Ethics of Decision Making," describes how ob.gyns. can ethically help patients make decisions about surgical treatment when there is a lack of firm evidence for or against such surgery.

The committee illustrates the decision making process by discussing elective cesarean delivery in normal pregnancy, also known as "patient choice cesarean" or "cesarean on demand."

The decision in this case is complicated by the lack of data on the risks and benefits of cesarean vs. vaginal delivery, the committee said.

In the absence of such data, "the burden of proof should fall on those who are advocates for a change in policy in support of elective cesarean delivery.... If the physician believes that cesarean delivery promotes the overall health and welfare of the woman and her fetus more than vaginal birth, he or she is ethically justified in performing a cesarean delivery," the document says (Obstet. Gynecol. 102[5]:1101-06, 2003).

Similarly, physicians who believe that performing a cesarean would be detrimental should refrain from performing the surgery and refer the patient to another health care provider if physician and patient cannot agree on a delivery method.