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The professional responsibility model of obstetric ethics and caesarean delivery

机译：产科伦理与剖腹产的职业责任模型

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In this chapter, we provide an account of the professional responsibility model of obstetric ethics, and identify its implications for two major topics: patient-choice caesarean delivery and trial of labour after caesarean delivery. The professional responsibility model of obstetric ethics is based on the ethical concept of medicine as a profession and the ethical principles of beneficence and respect for autonomy. The obstetrician has beneficence-based and autonomy-based obligations to the pregnant woman and beneficence-based obligations to the fetus when it is a patient. Because the viable fetus is a patient, the ethics of caesarean delivery requires balancing of obligations to the pregnant and fetal patient. The implication of the professional responsibility model for patient-choice caesarean delivery is that the obstetrician should respond to such requests with a recommendation against non-indicated caesarean delivery and for vaginal delivery. These recommendations should be explained and discussed in the informed consent process. It is ethically permissible to implement an informed, reflective decision for non-indicated caesarean delivery. The implication for trial of labour after caesarean delivery is that, in settings properly equipped and staffed, the obstetrician should offer both trial of labour after caesarean delivery and planned caesarean delivery to women who have had one previous low transverse incision. The obstetrician should recommend against trial of labour after caesarean delivery for women with a previous classical incision. ? 2012 Elsevier Ltd. All rights reserved.
机译：在本章中，我们将介绍产科伦理学的职业责任模型，并确定其对两个主要主题的影响：患者选择剖腹产和剖腹产后的分娩试验。产科伦理学的职业责任模型基于医学作为一种职业的伦理学概念，以及仁慈和尊重自治的伦理原则。产科医生对孕妇负有基于福利和自主权的义务，对胎儿负有基于福利的义务。因为有生命的胎儿是患者，所以剖腹产的伦理要求平衡对孕妇和胎儿患者的义务。病人选择剖腹产的专业责任模型的含义是，产科医生应针对此类要求做出回应，并建议不要进行剖腹产和阴道分娩。这些建议应在知情同意过程中进行解释和讨论。从伦理上允许对非指示性剖腹产实施明智的反思性决定。剖腹产后进行分娩试验的含义是，在设备和人员配备适当的环境中，产科医生应为剖腹产后的分娩试验和计划中的剖腹分娩者提供既往的手术，这些妇女以前曾有过低横向切口。产科医师应建议避免对先前有经典切口的妇女进行剖腹产后进行分娩试验。 ？ 2012 Elsevier Ltd.保留所有权利。

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