At 18:00 04/04/05 +0100, Janet Shapiro wrote:
With
regard to the effect that fear of litigation may influence the rise in
Caesarean deliveries, I noted a comment by Christine Hogg in Health
Matters 39 Winter 1999/2000.
"Experience in the US shows that litigation affects clinical
practice. It leads to defensive medicine (that is, over
treatment).....
Or 'under-treatment' in some cases. One of the most disturbing
things I ever heard said on this issue was from a US obstetrician a
number of years ago, who indicated that a number of his colleagues had
realised that, in terms of litigation/ damages, a dead baby was 'much
cheaper' than a live baby with severe lasting consequences of birth
trauma.
In this country, the continuing
rise in Caesareans – in spite of evidence of the dangers and national
policy – is attributed to defensive medicine, although it may be used as
an excuse by a profession that prefers intervention to
waiting."
Even if some members of the profession prefer intervention, the reasons
for feeling the need to practise defensive medicine remain very real, so
would never be more than a partial excuse unless the litigation etc.
situation changed dramatically. As for 'the dangers', there is
always going to be somewhat of a problem due to the fact that the
interests of the mother and baby may often be in conflict.
The article was about the less
desirable consequences of introducing 'choice' into medical
care.
In general, I am a great believer in the idea that sane adults should
have as complete as possible choice in terms of their healthcare.
They already have it in a negative sense, in that they have the right to
refuse to consent to anything, even if that decision is clearly contrary
to their interests, but they do not have any intrinsic right to 'demand'
a treatment which is not proposed. Whether ethical considerations
and the consciences of doctors can be reconciled to giving treatment they
believe is inappropriate/dangerous is another matter, even though that
issue already exists ('the other way around') in relation to 'refused
treatment'. However, in terms of obstetrics, the whole question of
maternal choice is very much confused by the existence of a third party
(the baby) whose survival/wellbeing can be influenced by maternal
choices.
Kind Regards,
John
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Dr John Whittington,
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Mediscience Services
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