Making sense of rising caesarean section rates

Editor—We agree with Anderson that we should have a more comprehensive and frank debate about the ethical issues related to the role of doctors, preferences of patients, and informed consent with respect to caesarean section.¹ In response to Minkoff et al,² we argued that not offering caesarean section was incompatible with the principle of autonomy.³

Particularly in English speaking countries, the historical role of the doctor is changing, thanks to the increasing reliance on a model where the patient is seen as the consumer and the doctor as supplier of services.⁴ The paternalistic model is still strong in Europe, and the debate about caesarean section may simply reflect today's difficulties in building a new form of doctor-patient relationship.

Nowadays, trust is not enough for patients: they need proof and evidence. But medicine is both an art and a science, and sometimes there is no clear proof or evidence. Is trust still possible at the very time a major medical liability crisis is happening worldwide?⁵ Answering this question may be as long, difficult, and important as waiting for the results of any randomised controlled trial.