Public Health Law Map - Beta 5 - Medical and Public Health Law Site

lifesaving care. Many physicians ignore the refusal on the basis that the woman will
change her mind if the section becomes necessary or in the hope that a section will
not be required. This is a dangerous approach if an emergency section becomes
necessary. Since there will be no time to obtain a court order, the physician must
choose between respecting the woman’s wishes or operating against her consent.
Irrespective of the patient’s expressed wishes, it will be difficult to defend allowing
the patient and baby to die. The best that can be expected is a verdict based on the
court’s requiring the enforcement of a rigorously documented informed refusal of
care. Conversely, operating against a patient’s express refusal, without judicial
authorization, is legally and ethically unacceptable.
G. Home Deliveries
There is little legal experience with home deliveries because very few home deliveries
in the United States are attended or supervised by physicians. Although there is a
small, visible group of middle-class and affluent women seeking home deliveries, most
women delivered at home are poor and would prefer to be delivered in a hospital by a
physician. Once these women are in labor, they can be brought into the hospital under
the antidumping provisions of the Medicare/Medicaid laws, but they will still be
responsible for their medical bills. These poor women pose a dilemma for physicians
because of the conflict between their desire to help the woman avoid the hospital costs
and the ethical and legal problems in engaging in potentially substandard care.
1. The Politics of Home Deliveries
Women who choose home deliveries because of political beliefs or involvement in
quasi- religious antimedical groups are problematic because they usually have high
expectations. Many believe that by avoiding the medicalization of birth, they will
have a unique experience and a perfect baby. Physicians who might otherwise
consider supervising a home delivery should be very cautious when working with a
patient who has such unrealistic beliefs. The greatest threats posed by such patients
are the refusal of necessary hospitalization should an emergency arise and the delay
in getting hospital care once the patient agrees.
Even if the physician has discussed this possibility and documented the patient’s
agreement to hospitalization in the birth plan, the patient retains the right to refuse a
transfer to the hospital. This can put the physician in the ethical and legal bind of a
patient’s refusing emergency medical care that is necessary to preserve her and her
baby’s health. There is no time for a court order for care, and, unlike the usual
situation where the patient is in the emergency room, the patient must be transported
against her will to make the care possible.
2. Participating in Home Deliveries
As long as a home delivery is successful, the physician is not at any special legal
risk. If the mother or the baby is injured because of a complication that could have
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