Making sense of rising caesarean section rates
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《英国医生杂志》
EDITOR—We agree with Anderson that we should have a more comprehensive and frank debate about the ethical issues related to the role of doctors, preferences of patients, and informed consent with respect to caesarean section.1 In response to Minkoff et al,2 we argued that not offering caesarean section was incompatible with the principle of autonomy.3
Particularly in English speaking countries, the historical role of the doctor is changing, thanks to the increasing reliance on a model where the patient is seen as the consumer and the doctor as supplier of services.4 The paternalistic model is still strong in Europe, and the debate about caesarean section may simply reflect today's difficulties in building a new form of doctor-patient relationship.
Nowadays, trust is not enough for patients: they need proof and evidence. But medicine is both an art and a science, and sometimes there is no clear proof or evidence. Is trust still possible at the very time a major medical liability crisis is happening worldwide?5 Answering this question may be as long, difficult, and important as waiting for the results of any randomised controlled trial.
Guillaume Gorincour, senior radiologist
ggorincour@voila.fr, La Timone Children Hospital, F-13385 Marseilles, France
Sébastien Tassy, Mediterranean ethical forum
La Timone Children Hospital, F-13385 Marseilles, France
Competing interests: None declared.
References
Anderson GM. Making sense of rising caesarean section rates BMJ 2004;329; 696-7. (25 September.)
Minkoff H, Powderly KR, Chervenak FA, McCullough LB. Ethical dimensions of elective primary cesarean delivery. Obstet Gynecol 2004;103: 38-9.
Tassy S, Gorincour G, Banet J, d'Ercole C. Ethical dimensions of elective primary cesarean delivery. Obstet Gynecol 2004;104: 192; author's reply, 193.
Kennedy I. Patients are experts in their own field. BMJ 2003;326: 1276-7.
Tassy S, Gorincour G. Ethical response to liability crisis. Am J Obstet Gynecol (in press).
Particularly in English speaking countries, the historical role of the doctor is changing, thanks to the increasing reliance on a model where the patient is seen as the consumer and the doctor as supplier of services.4 The paternalistic model is still strong in Europe, and the debate about caesarean section may simply reflect today's difficulties in building a new form of doctor-patient relationship.
Nowadays, trust is not enough for patients: they need proof and evidence. But medicine is both an art and a science, and sometimes there is no clear proof or evidence. Is trust still possible at the very time a major medical liability crisis is happening worldwide?5 Answering this question may be as long, difficult, and important as waiting for the results of any randomised controlled trial.
Guillaume Gorincour, senior radiologist
ggorincour@voila.fr, La Timone Children Hospital, F-13385 Marseilles, France
Sébastien Tassy, Mediterranean ethical forum
La Timone Children Hospital, F-13385 Marseilles, France
Competing interests: None declared.
References
Anderson GM. Making sense of rising caesarean section rates BMJ 2004;329; 696-7. (25 September.)
Minkoff H, Powderly KR, Chervenak FA, McCullough LB. Ethical dimensions of elective primary cesarean delivery. Obstet Gynecol 2004;103: 38-9.
Tassy S, Gorincour G, Banet J, d'Ercole C. Ethical dimensions of elective primary cesarean delivery. Obstet Gynecol 2004;104: 192; author's reply, 193.
Kennedy I. Patients are experts in their own field. BMJ 2003;326: 1276-7.
Tassy S, Gorincour G. Ethical response to liability crisis. Am J Obstet Gynecol (in press).