A physician goes to labor and delivery on Friday evening to check on the labor progression of her patient. The patient has had a protracted labor course throughout the day. Her cervical dilation has increased 1 cm over the last 3 hours, and she is now at 8 cm dilation. The patient's vital signs are normal, and the fetal heart rate tracing is category 1. The physician is leaving town for vacation in a few hours, but an on-call obstetrician will be available for deliveries. The physician recommends a cesarean delivery to the patient because of the protracted labor course and the physician's inability to be at the delivery in a few hours. This situation demonstrates which of the following ethical principles?

Question

A physician goes to labor and delivery on Friday evening to check on the labor progression of her patient.  The patient has had a protracted labor course throughout the day.  Her cervical dilation has increased 1 cm over the last 3 hours, and she is now at 8 cm dilation.  The patient's vital signs are normal, and the fetal heart rate tracing is category 1.  The physician is leaving town for vacation in a few hours, but an on-call obstetrician will be available for deliveries.  The physician recommends a cesarean delivery to the patient because of the protracted labor course and the physician's inability to be at the delivery in a few hours.  This situation demonstrates which of the following ethical principles?

Quizplus · Accepted Answer

This patient has a protracted active phase of labor and is unlikely to deliver in the few hours before the provider leaves for vacation. However, the patient has normal vital signs, a category 1 fetal heart rate tracing, and an available on-call obstetrician capable of managing her labor and delivery. Therefore, the most appropriate management is continued labor for a possible vaginal delivery, even if the initial physician cannot attend (and therefore charge for) the delivery because vaginal delivery has fewer maternal risks and shorter recovery times than cesarean delivery (Choice A). Instead, the physician in this case is an example of a conflict of interest because the recommended clinical management (eg, cesarean delivery) is out of self-interest and/or personal convenience (ie, expediting delivery prior to leaving for vacation), thereby influencing or biasing the process of informed consent. Providers are obligated to inform the patient of all medically reasonable alternatives (eg, vaginal delivery) and provide medical care that is most likely to yield the greatest benefit to the patient, regardless of personal interest. (Choice C) Directive counseling occurs when a provider recommends only 1 management option (eg, cesarean delivery for vasa previa, placenta previa) because there is only 1 medically reasonable treatment with clearly superior evidence-based support. vasa previa (Choice D) Justice is the ethical principle of fair and equitable treatment, such as equal distribution of scarce medical resources, lack of discrimination when providing medical care, and adherence to applicable laws. (Choice E) Preventive ethics occurs when a consent process helps anticipate and prevent future ethical issues. An example is obtaining informed consent at a routine obstetric visit for cesarean delivery rather than intrapartum when emergency decisions may be required. (Choice F) In this situation, veracity (ie, being truthful to patients) would occur if the physician acknowledged that vaginal delivery is still possible and safe for this patient and that a cesarean delivery is not required. Educational objective: Conflict of interest occurs when the process of informed consent is influenced or biased by a provider's self-interest. Providers are obligated to inform patients of all medically reasonable alternatives and provide care that is most likely to yield the greatest benefit to the patient. References: Informed consent-it's more than a signature on a piece of paper. (http://www.ncbi.nlm.nih.gov/pubmed/28974311)

A Physician Goes to Labor and Delivery on Friday Evening