tag:blogger.com,1999:blog-9112840065540727972.post7653373487023679244..comments2023-11-02T08:30:40.051-04:00Comments on A Blog on Bioethics: More on NHS and C-SectionsStephen Lathamhttp://www.blogger.com/profile/05522413778422149522noreply@blogger.comBlogger2125tag:blogger.com,1999:blog-9112840065540727972.post-89864890847402108532011-11-08T00:13:29.101-05:002011-11-08T00:13:29.101-05:00I'm not quite sure I understand how we can say...I'm not quite sure I understand how we can say that there is a disincentive for doctors to perform c-sections, though, when the statistics indicate that physicians are more likely to introduce the topic of c-sections than women are. Doesn't this quantitatively determine that doctors are at least neutral on the subject, because a disincentive would at least cause them to wait until the option is brought up by the patient?foxinsocks14https://www.blogger.com/profile/02979102225291749509noreply@blogger.comtag:blogger.com,1999:blog-9112840065540727972.post-73305657012230670372011-11-03T04:54:55.738-04:002011-11-03T04:54:55.738-04:00Hmmmm - I'd still dispute whether there's ...Hmmmm - I'd still dispute whether there's all that much of a connection between the NICE guidelines and your worries, for the reasons I suggested in my post: I think that there <i>is</i> - as a matter of bare logic - a leap between provision at the mother's request and provision at the medic's. But, leaving that aside, it seems to remain the case that, if the medic was pressing for a c-section, then NICE guidelines on maternal request would make not a whit of difference. If your obstetrician is the kind of person who is going to pressure you into having a c-section, he's going to be the kind of person to pressure you into having a c-section irrespective of what NICE says about voluntary ones.<br /><br />You seem to identify three push-factors that would make a medic more likely to pressurise a woman towards a c-section: method of reimbursement, physician time demands, and fear of medical malpractice lawsuits. The first can, I think, be dismissed fairly easily, since the NHS means that money can be taken out of healthcare provision. Nor am I sure what the grounds would be for any kind of malpractice suit - so I'm tempted to relegate the importance of that.<br /><br />That leaves the question of physician time demands. But here, I'm not sure that that makes all that much of a difference, not least because - as far as I understand - most of the medical attention during labour comes from nursing and midwifery staff, rather than doctors (on which, see <a rel="nofollow">http://www.nhs.uk/planners/pregnancycareplanner/pages/birthoptions.aspx</a>). So it seems that there's actually a disincentive for doctors to encourage unnecessary surgical procedures, because it'll mean that there's more for them to do.Iainnoreply@blogger.com