Kukla Rebecca, Kuppermann Miriam, Little Margaret, Lyerly Anne Drapkin, Mitchell Lisa M, Armstrong Elizabeth M, Harris Lisa
University of South Florida.
Bioethics. 2009 Jan;23(1):1-8. doi: 10.1111/j.1467-8519.2008.00677.x.
Over the last several years, as cesarean deliveries have grown increasingly common, there has been a great deal of public and professional interest in the phenomenon of women 'choosing' to deliver by cesarean section in the absence of any specific medical indication. The issue has sparked intense conversation, as it raises questions about the nature of autonomy in birth. Whereas mainstream bioethical discourse is used to associating autonomy with having a large array of choices, this conception of autonomy does not seem adequate to capture concerns and intuitions that have a strong grip outside this discourse. An empirical and conceptual exploration of how delivery decisions ought to be negotiated must be guided by a rich understanding of women's agency and its placement within a complicated set of cultural meanings and pressures surrounding birth. It is too early to be 'for' or 'against' women's access to cesarean delivery in the absence of traditional medical indications--and indeed, a simple pro- or con- position is never going to do justice to the subtlety of the issue. The right question is not whether women ought to be allowed to choose their delivery approach but, rather, taking the value of women's autonomy in decision-making around birth as a given, what sorts of guidelines, practices, and social conditions will best promote and protect women's full inclusion in a safe and positive birth process.
在过去几年中，随着剖宫产越来越普遍，公众和专业人士对女性在没有任何特定医学指征的情况下“选择”剖宫产这一现象产生了极大兴趣。这个问题引发了激烈的讨论，因为它引发了关于分娩中自主性本质的问题。虽然主流生物伦理话语习惯于将自主性与拥有大量选择联系起来，但这种自主性概念似乎不足以涵盖在这种话语之外有着强烈影响力的担忧和直觉。对分娩决策应如何协商进行实证和概念性探索，必须以对女性能动性及其在围绕分娩的一系列复杂文化意义和压力中的定位的深刻理解为指导。在没有传统医学指征的情况下，支持或反对女性进行剖宫产还为时过早——事实上，简单的支持或反对立场永远无法公正地对待这个问题的微妙之处。正确的问题不是女性是否应该被允许选择分娩方式，而是，在将女性在分娩决策中的自主性价值视为既定的情况下，什么样的指导方针、做法和社会条件将最能促进和保护女性充分融入安全、积极的分娩过程。
