医生是不是可以（或者需要）在孕妇（/家属）拒绝的情况下，为了胎儿的利益而做剖腹产手术？这个问题被最近在中国发生的一个案例炒得很热。有所谓法律专家煞有介事地出来胡说八道美国如何如何，跟我们在美国学到的医疗伦理学原则大相迳庭。Patient autonomy 是 usmle 考试的一个很基本的伦理学问题, 1987年发生在美国首都乔治华盛顿大学医学中心的一个案例，明确而彻底地回答了为了胎儿的利益而做剖腹产手术的问题，从此以后，医院和医生再也不需要通过法庭来决定是否可以做剖腹产手术。
1、A fetus cannot have rights in this respect superior to those of a person who has already been born.
2、Appellate court decisions have rejected the argument that a pregnant woman has a legal duty to guarantee the health and well-being of her fetus.
3、The District of Columbia Court of Appeals also rejected that a woman who \"has chosen to lend her body to bring [a] child into the world\" has an enhanced duty to assure the welfare of the fetus, sufficient even to require her to undergo Caesarean surgery.
No more court orders, no more arguements. It is pregnant women\'s right to refuse
In recent years physicians in various parts of the country began appealing
to the courts when pregnant women refused to undergo treatment on behalf of
their fetus. In the majority of cases, the courts sided with physicians and
ordered women to undergo cesareans against their will. However, appellate
decisions (which hold the force of law) have since upheld the right of
pregnant women to refuse treatment, even in situations where their physician
believes the life of the fetus to be threatened.
The most widely cited case, In Re. A.C., involved Angela Carder, a pregnant
cancer patient who fused to consent to a cesarean at 25 weeks gestation
and stated that she wanted to undergo cancer treatment instead, which her
doctors believed would kill her fetus. Officials at George Washington
University Hospital intervened and obtained a court order to force her to
undergo a cesarean that neither she nor her baby survived. Her estate
appealed the decision and won. The Court of Appeals upheld the right of
pregnant women to make all medical decisions on behalf of themselves and
their fetuses, arguing that to compel invasive treatment on pregnant women
would give fetuses rights superior to those of the mother and diminish the
rights of born children whose parents could not, by law, be forced to
undergo surgery or donate organs on their behalf. The court further ruled
that the viability of the fetus and any potential harm the mother might
cause to it by refusing treatment could not override her fundamental right
to bodily integrity and informed consent/refusal.
It’s important for VBAC mothers to know that the Carder ruling has had a
very chilling effect on the willingness of doctors or hospitals to use the
courts to force women to undergo cesareans. Many continue to use the
prospect of a court order as a threat to coerce women to consent, but
hospitals, doctors, and their attorneys are well aware that, should they
proceed and should the mother decide to appeal, they’re looking at a long
and expensive legal battle that they will lose in the end. Any VBAC mother
who’s threatened with a court-ordered cesarean should inform staff that she
knows that it’s an empty threat, that case law is on her side, and that
she plans to appeal the ruling all the way to the Supreme Court if need be.
Cited from: International Cesarean Awareness Network, Inc.
Enforcing and Promoting the Rights of Women Seeking Vaginal Birth After
Cesarean (VBAC): A Primer