Refusal of Care

Refusal of a C-Section
Obstetrics is the only field in medicine in which decisions made by one person immediately impact the outcome of another. Two patients’ lives are at stake in one instance.
Hani, a 28-year-old refugee (39 weeks in her first pregnancy), arrives to the obstetrical department at a local hospital in labor. She continues to labor for several hours making slow but steady progress. However, fetal heart rate and fetal movement suddenly decline. Non-surgical interventions are attempted without success and an emergency Cesarean section (C-section) is imminent. The team meets with the patient and family to discuss the condition of the fetus and considerations for a safe delivery for both mom and baby. The risks, benefits, and alternatives are offered; however, citing religious and cultural objections, Hani refuses the C-section procedure, as does her spouse. Her family also is at her side and agrees with her decision. Hani has the capacity to make her own healthcare decisions.
Getting to Know Your Patient
Upon further discussion, the health care team learns Hani and their family immigrated to the United States only four months ago. Prenatal care was obtained here in the United States through a local community refugee clinic. With their arrival to the U.S., the patient and family brought forth skepticism towards U.S. medical care especially during childbirth, citing that “women are cut” here when nature could easily take a natural course.
It is also learned that surgical procedures performed on women in their home country are typically not survived by mother and/or infant; moreover, the patient’s mother shares that her eldest daughter died in childbirth after experiencing a similar situation that Hani now faces.

Article for your review: Management of Pregnant Patients Who Refuse Medically Indicated Cesarean Delivery: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3594862/

Reflect on and answer the following questions:
In healthcare, general ethical principles include autonomy (patient self-decision making), beneficence (benefit or best interest of the patient), nonmaleficence (providers do not harm their patients), as well as veracity (truthfulness), and justice (fairness).
Be sure to answer each question by numbering your responses to correspond to the numbered question:
1. Picture yourself at the patient’s bedside. What issues might a healthcare team member find difficult to cope with in this situation?
2. What would you do if caring for this patient created a moral dilemma for you personally? How would you take care of yourself?
3. You notice that one of the healthcare team members tries to scare Hani into making a decision that is in agreement with the team member but counters Hani’s wishes. What could you do in this situation?
4. Argue for or against patient autonomy on behalf of the mother vs. beneficent and justice on behalf of the fetus.

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