Cape Breton University, Canada.
Am J Bioeth. 2012;12(7):44-52. doi: 10.1080/15265161.2012.673689.
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.
剖宫产率在全球范围内稳步上升。对此，许多国家都提出了降低剖宫产率的目标。但是，关注目标并不能解决护理标准中存在的问题，这些问题鼓励而不是阻止剖宫产。产科护理标准使技术的使用规范化，这使得在分娩期间使用技术成为必要。如果医生或患者担心拒绝使用技术，那么技术的必要性就会导致剖宫产率上升。生殖自主权受到威胁，因为技术的必要性会削弱患者选择剖宫产或拒绝使用技术的能力，从而增加剖宫产的可能性。为了解决由技术必要性驱动的实践问题，我概述了医生尊重患者自主权的三项义务。这些道德义务表明，关注对自主权的尊重不仅可能是一种理想的伦理反应，而且可能是降低剖宫产率的一种可行的实际反应。
