Abstract
Cesarean delivery rates have been steadily increasing worldwide. In response, many countries have introduced target goals to reduce rates. But a focus on target goals fails to address practices embedded in standards of care that encourage, rather than discourage, cesarean sections. Obstetrical standards of care normalize use of technology, creating an imperative to use technology during labor and birth. A technological imperative is implicated in rising cesarean rates if physicians or patients fear refusing use of technology. Reproductive autonomy is at stake since a technological imperative undermines patients’ ability to choose cesareans or refuse use of technology increasing the likelihood of cesareans. To address practices driven by a technological imperative I outline three physician obligations that are attached to respecting patient autonomy. These moral obligations show that a focus on respect for autonomy may prove not only an ideal ethical response but also an achievable practical response to lowering cesarean rates.
Acknowledgments
I worked on this project while at The Canadian Centre for Ethics and Public Affairs as a Scholar in Residence and Dalhousie University as a Visiting Scholar and I am grateful to the support of each. I am thankful for the support of Susan Sherwin and feedback from the members of Dalhousie University's Novel Tech Ethics team on a much earlier version of this paper, in particular Tim Krahn, Samantha Copeland, Andrew Fenton, Sid Johnson, Serife Tekin, Matthew Herder, Simon Outram, and Andrea Smith.
Notes
Regarding decisions as autonomous if they are “truly one's own” follows a tradition of autonomy theory sparked by Harry Frankfurt (Citation1971), Gary Watson (Citation1975), and Gerald Dworkin (Citation1976) and sustained in more recent work by Christman (Citation1991), Friedman (Citation2003), and Meyers (Citation1989) (see also Taylor 2005).
These numbers are estimated using 2003 nationwide data on delivery methods.