“The worth of the person is not affected by disease, disability, functional status or proximity to death…nursing care aims to maximize the values that the patient has treasured in life,” (American Nurses Association [ANA], 2001). While all of the core principles in biomedical ethics have crucial significance in healthcare, respect for patient autonomy and the right to self-determination weigh heavily on the quality of nursing practice. As stated in the first provision of The Code of Ethics for Nurses (2001), “the nurse…practices with compassion and respect for the inherent dignity, worth, and uniqueness of every individual.” This provision emphasizes the magnitude of an individual’s right to autonomy and self-determination in recognizing and respecting human dignity. It sets a standard of priority in nursing practice, and decision-making that sets the foundation to improve overall quality of life (Beauchamp, & Childress, 2009). Although pathophysiological processes generally serve as the basis for healthcare, nurses are continually advocate for, and treat, the patient, not the disease. This concept is frequently demonstrated by the practice of informed consent, the right to refuse medical treatments or procedures, and the right of patients to receive accurate information and be actively involved in their health and the care they receive
A rising dilemma in women’s health today is the controversy over vaginal birth after cesarean (VBAC). Many healthcare providers, hospital institutions, and insurance companies have outlawed the option for women with a prior C-section to have subsequent deliveries vaginally. As the rate of cesarean deliveries steadily rises, women will be forced to abandon their right to childbirth and self-determination by involuntarily consenting to an unnaturally invasive procedure.
While the latest practice guidelines agree that trial of labor after cesarean (TOLAC) is generally safe for most women in the absence of contraindication (American College of Obstetricians and Gynecologists, [ACOG], 2010), the risk for complications and ensuing lawsuit liability has led to loss of VBAC support from nearly a third of hospitals and at least ½ of obstetrical practitioners (NIH Conference Statement, 2010). In recent surveys regarding VBAC litigation and liability, ACOG confirmed assumptions that liability concerns had significant influence on recent childbirth practices. Nearly 20% of providers refused TOLAC services due to high costs of malpractice insurance despite patient preferences and requests (ACOG, 2009).
Although VBAC and TOLAC are acceptable child birthing practices, the moral interests in ethical principles are heavily in question. While uterine ruptures have accounted for less than 1% of failed attempts of TOLAC, the resulting incidence of neonatal disability associated with uterine rupture is significantly less than the risk of some invasive diagnostic procedures, such as chorionic villus sampling and amniocentesis (Bonanno, Clausing, & Berkowitz, 2011). Additionally, cesarean deliveries have been associated with greater incidences in postpartum depression, posttraumatic stress disorder, and negative perceptions of the child birthing experience (Lobel & DeLuca. 2007).
Thus, the argument for support of beneficence and nonmaleficence is lacking in sufficient integrity. Furthermore, justice cannot be regarded due to the inequality of interests being served by providers choosing to preserve legal and social precedence in place of patient values and beliefs (Beauchamp, & Childress, 2009). The remaining principle of moral service and professionalism demonstrates the significance of patient centered values, and human dignity to support the superior influence of self determination and respect for autonomy in biomedical ethics.
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American College of Obstetricians and Gynecologists. ACOG Practice bulletin no. 115: vaginal birth after previous cesarean delivery. Obstetrics & Gynecology, 116: 450–63.
American College of Obstetrician Gynecologists. ACOG survey on professional liability. American College of Obstetrician Gynecologists.
American Nurses Association, (2001). Code of Ethics for Nurses. Nursebooks.org: Silver Spring, MD.
Bonanno, Clausing, & Berkowitz, (2011) VBAC: A Medicolegal Perspective. Clinical Perinatology, 38: 217–225
Lobel M., & DeLuca, R., (2007). Psychosocial sequelae of cesarean delivery: Review and analysis of their causes and implications. Social Science of Medicine, 64(11):2272–84.
NIH Conference Statement. Vaginal birth after cesarean. Obstetrics & Gynecology, 115:1279–95.