Welcome to Ethics Consult -- an opportunity to discuss, debate (respectfully), and learn together. We select an ethical dilemma from a true, but anonymized, patient care case. You vote on your decision in the case and, next week, we'll reveal how you all made the call. Bioethicist Jacob M. Appel, MD, JD, will also weigh in with an ethical framework to help you learn and prepare.
The following case is adapted from Appel's 2019 book, .
Amber, a single 22-year-old woman, is a professional bikini model. She decides to have a baby on her own.
After becoming pregnant, Amber is clear with her obstetrician that she will absolutely not have a cesarean section, because she's worried about a scar affecting her career. When the obstetrician explains that some C-sections are medically necessary, she says, "You cut me, and I'll sue your pants off." As a result, she is "fired" by a series of ob/gyns until she learns not to mention C-sections at the first meeting. She decides to wait to tell her new ob/gyn until she is ready to deliver.
Unfortunately, 9 months into the pregnancy, and only days from Amber's due date, the fetus develops severe complications. Without an immediate C-section, the fetus will likely die. Amber refuses to consent. There is not enough time to bring the matter to a court for adjudication.
See the results and what an ethics expert has to say.
Jacob M. Appel, MD, JD, is director of ethics education in psychiatry and a member of the institutional review board at the Icahn School of Medicine at Mount Sinai in New York City. He holds an MD from Columbia University, a JD from Harvard Law School, and a bioethics MA from Albany Medical College.
Check out some of our past Ethics Consult cases:
Allow Ineligible Medicaid Recipient to Receive Novel Drug?