ACOG: Ask why patient wants surgery

An ethical opinion from the ob-gyn group offers a structure for dealing with requests for potentially risky treatment.

By Andis Robeznieks, amednews staff. Dec. 15, 2003.

Patients do not have the right to demand treatment that a doctor believes may be unwise or high-risk, according to an ethical opinion recently adopted by the American College of Obstetricians and Gynecologists.

ACOG Committee on Ethics opinion 289 states that if a patient and physician cannot agree on an elective procedure, it is appropriate to refer the patient to another doctor.

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It also states that physicians are under no obligation to initiate discussion of elective procedures if they don't see the medical benefit.

This opinion was perceived by many to be a statement on elective cesarean delivery, but Robert P. Lorenz, MD, an ethics committee member, disagreed with this perception.

"Cesarean section is merely one example, but obviously that's the most newsworthy part of the document," said Dr. Lorenz, director of maternal fetal medicine at William Beaumont Hospital in Royal Oak, Mich.

"This is not an American College of Obstetricians and Gynecologists endorsement of cesarean section on demand," he said. "Rather, it's an ethical structure on how to approach the patient's request."

For example, if a woman requests a cesarean because she is concerned with the pain of going through labor, Dr. Lorenz said the woman's physician should then discuss the various methods of dealing with the pain rather than instantly accepting or dismissing the request.

Likewise, if a young woman requests sterilization because she is concerned about passing along a genetic disorder, he said the physician should discuss how embryos created by in vitro fertilization can be screened for genetic disorders before implantation in her uterus.

"The best way to address this or any other situation where the patient comes in with specific demands is to understand the reason for the request," Dr. Lorenz said.

ADDITIONAL INFORMATION:

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American College of Obstetricians and Gynecologists opinion addressing elective cesarean controversy (www.acog.org/from_home/publications/press_releases/nr10-31-03-1.cfm)