Legal aspects of consent 11: compulsory Caesarean sections

Abstract

Case Scenario: Miss MB required a Caesarean section in order to save her fetus. However, while she gave consent to the operation, she suffered from a needle phobia which caused her to panic and refuse the preliminary anaesthetic. The trust applied for a declaration that the Caesarean section could take place on the grounds that the needle phobia rendered her mentally incapacitated and therefore the operation should proceed in her best interests (Re MB (an adult: medical treatment), [1997]).

Holy consent – a dilemma for medical staff when maternal consent is withheld for emergency caesarean section

“…7 Forced court-ordered caesarean sections have been discussed in medical literature following several cases around the globe. 1,2,8 Most cases have concerned nonurgent surgery. 1 Cases have been discussed in which court orders have been obtained quickly (up to 48 min), but in none of these was there actual fetal distress.…”

“…Maternal refusal of consent has been discussed in terms of legal and ethical implications but rarely in connection with emergency cases. [1][2][3] We wish to communicate the impact on the medical staff of a motherÕs refusal of emergency caesarean section.…”

Can cesarean section be performed without the woman's consent?

“…The mother's mortality rate or risk of serious injury is low but increases with emergency surgery (4). The woman may refuse cesarean section for various reasons, even when the life of the fetus is in danger, for instance because of fear for her own life and health, carelessness, lack of understanding the seriousness of the situation, an unwanted child, psychiatric disorders, or religious reasons (1–3,5).…”

“…In a report from the USA, 81% of women refusing cesarean section were Black, Hispanic, or Asian, and 25% did not have English as their first language (6). In England, pregnant women refused cesarean section because of the fear of injections or psychiatric diseases, without understanding the consequences of their choices (2).…”

“…In Norway, little has been reported about forced cesarean section, and such a case has never been brought to court. However, cesarean section without consent has been reported from several other countries (1)(2)(3). In this article, we present cases from Norway that illustrate some of the ethical and moral problems related to forced cesarean section, and we discuss these problems and associated legal problems.…”