Elective caesarean section on request
Authors: P. de Zulueta, B. Norman, J. A Crowhurst, F. Plaat, G. M Stirrat, P. M Dunn, T. O Idama, S. W Lindow, J. van Roosmalen, A. Rosenthal, R. J Howard
Journal: BMJ (1999)

# Patients do not have right to impose their wishes at all cost {#article-title-2} EDITOR—Paterson-Brown seems to assume that an autonomous patient has an unconditional right to have her wishes fulfilled.1 The (negative) right to decline treatment needs to be distinguished from the supposed (positive) right to demand it. In English law, the principle of autonomy allows, for example, competent people the right to refuse life saving treatment, and doctors have a correlative duty to respect this right.2 A dying patient, however, does not have the right to impose a duty on a healthcare professional to end his or her life. With respect to medical and surgical interventions, the law is also clear. A patient, however competent, cannot invariably impose his or her demands and force a practitioner to act in a way which he or she believes to be contrary to the patient's best interests. This prerogative would be viewed by the courts as "an abuse of power as directly or indirectly requiring the practitioner to act contrary to the fundamental duty which he owes to his patient" (per Lord Donaldson).3 Healthcare professionals could not preserve their professional integrity, self respect, or credibility if they were to act as mere instruments to the "foolish" or "irrational" demands of patients, particularly if this ran contrary to good medical practice or violated their deeply held values.4 Decision making should be a collaborative enterprise based on mutual respect with the shared goal of the good of the patient. Distributive justice also deserves consideration here. If patients demand expensive treatments such as caesarean sections, in circumstances for which there is little or no evidence of benefit—and, indeed, there may be evidence of harm—the costs should be considered. The profession and the public, in the interest of patient welfare, should consider setting limits to personal autonomy and to professional self effacement. 1. ↵1. Paterson-Brown S, 2. Amu O, 3. Rajendran S, 4. Bolaji II .Should doctors perform an elective caesarean section on request?BMJ1998; 317:462–465. (15 August.) [OpenUrl][1][FREE Full Text][2] 2. ↵Re C (adult refusal of treatment) [1993] 15 BMLR 77. 3. ↵Re J (A minor) (Child in Care: Medical Treatment) [1992] 4 All ER 614, CA. 4. ↵1. General Medical Council .Good Medical Practice.London: GMC,1998. # All types of anaesthesia carry risks {#article-title-4} EDITOR—We agree with … [1]: {openurl}?query=rft.jtitle%253DBMJ%26rft.stitle%253DBMJ%26rft.issn%253D0007-1447%26rft.aulast%253DPaterson-Brown%26rft.auinit1%253DS.%26rft.volume%253D317%26rft.issue%253D7156%26rft.spage%253D462%26rft.epage%253D465%26rft.atitle%253DControversies%2Bin%2Bmanagement%253A%2BShould%2Bdoctors%2Bperform%2Ban%2Belective%2Bcaesarean%2Bsection%2Bon%2Brequest%253F%2B%2595%2BYes%252C%2Bas%2Blong%2Bas%2Bthe%2Bwoman%2Bis%2Bfully%2Binformed%2B%2595%2BMaternal%2Bchoice%2Balone%2Bshould%2Bnot%2Bdetermine%2Bmethod%2Bof%2Bdelivery%26rft_id%253Dinfo%253Apmid%252F9703532%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/ijlink?linkType=FULL&journalCode=bmj&resid=317/7156/462&atom=%2Fbmj%2F318%2F7176%2F120.atom