An ethical justification for emergency, coerced cesarean delivery.

OBJECTIVE

To provide an ethical justification for emergency coerced cesarean delivery without a court order when a pregnant woman refuses cesarean delivery.

METHODS

Ethical analysis is conducted of the existing literature and an ethical justification illustrated by a clinical example.

RESULTS

Absolute and near-absolute objections to coerced cesarean delivery fail for lack of adequate arguments to show that the woman's autonomy is not constrained by obligations to the at-term fetal patient. The ethical justification for emergency coerced cesarean delivery requires that three criteria be satisfied: 1) high reliability of the prognostic judgment that on balance cesarean delivery is expected to prevent serious infant morbidity or mortality, 2) lack of physical resistance that could significantly increase the risks of maternal or fetal harm from coerced cesarean delivery, and 3) insufficient time to consider a court order.

CONCLUSION

The obstetrician may justifiably coerce emergency cesarean delivery without a court order only when these three criteria are satisfied on a case-by-case basis.