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Database - Alliance francophone pour l'accouchement respecté (AFAR)

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Created on : 11 Jul 2018
Modified on : 11 Jul 2018

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Bibliographical entry (without author) :

An Orwellian scenario: court ordered caesarean section and women’s autonomy. Nurs Ethics. 1999 Nov

Author(s) :

Cahill H

Year of publication :

1999

URL(s) :

https://www.ncbi.nlm.nih.gov/pubmed/10696195
https://doi.org/10.1177/096973309900600605

Résumé (français)  :

Entre 1992 et 1996, un petit nombre de femmes au Royaume-Uni ont été contraintes par les tribunaux de subir une césarienne contre leur refus exprimé. L’analyse des cas rapportés révèle l’hypothèse générale de l’incompétence maternelle et l’utilisation répandue de la coercition à peine voilée. De telles attitudes et pratiques sont souvent elles-mêmes aggravées par une communication inadéquate. La discrétion médicale dans de tels cas problématiques semble pécher du côté de la sécurité et semble ainsi favoriser la vie du fœtus par rapport à l’autonomie maternelle. Malgré le placement actuel de la femme enceinte au centre des soins de maternité, les préoccupations des obstétriciens semblent davantage concerner le fœtus à naître. En d’autres termes, il semble y avoir un point où la valeur de la vie fœtale commence à l’emporter, pas tant sur la vie de la femme que sur son droit à l’autodétermination, ses projets et ses choix. Bien qu’il soit important de reconnaître que ces césariennes ordonnées par le tribunal représentent une extrême inhabituelle dans les soins de maternité contemporains dans ce pays, qu’elles ont eu lieu met en relief certaines des hypothèses stéréotypées sur les femmes. Ce sont des hypothèses qui sous-tendent une grande partie de la pratique médicale actuelle et peuvent compromettre ou affaiblir les femmes d’autres façons au cours de leur expérience de la grossesse et du travail. Utilisant le premier et le dernier des six cas rapportés comme illustrations contextuelles, cet article se concentre sur l’interaction complexe des processus qui ont amené la profession médicale à une position dans laquelle leur propre conviction et détermination à faire ce qu’ils croient être le mieux pour leur les patients ont abouti à un déni flagrant de l’autonomie des femmes et à l’utilisation de la loi pour passer outre au refus du consentement de la femme enceinte

Abstract (English)  :

Between 1992 and 1996, a small number of women in the UK were forced by the courts to undergo caesarean section against their expressed refusal. Analysis of the reported cases reveals the blanket assumption of maternal incompetence and the widespread use of thinly veiled coercion. Such attitudes and practices are themselves frequently compounded by inadequate communication. Medical discretion in such problematic cases seems to err on the side of safety and so appears to favour the life of the fetus over maternal autonomy. Despite current policy’s placement of the pregnant woman at the centre of maternity care, obstetricians’ concerns appear to lie more with the unborn fetus. In other words, there seems to be a point at which the value of fetal life begins to outweigh, not so much the life of the woman, but her right to self-determination, her plans and her choices. While it is important to acknowledge that these court ordered caesareans represent an unusual extreme within contemporary maternity care in this country, that they have happened brings into sharp relief some of the stereotypical assumptions about women. These are assumptions that underlie much of current medical practice and may compromise or disempower women in other ways during their experience of pregnancy and labour. Using the first and last of the six reported cases as contextual illustrations, this article focuses on the complex interplay of processes that have brought the medical profession to a position in which their own self-conviction and determination to do what they believe is best for their patients has resulted in gross denial of women’s autonomy and the use of the law to override pregnant women’s refusal of consent.

Sumário (português)  :

Entre 1992 e 1996, um pequeno número de mulheres no Reino Unido foi forçado pelos tribunais a submeter-se a uma cesariana contra a sua recusa expressa. A análise dos casos relatados revela a suposição geral da incompetência materna e o uso generalizado de coerção velada. Tais atitudes e práticas são freqüentemente compostas por comunicação inadequada. A discrição médica em tais casos problemáticos parece errar do lado da segurança e assim parece favorecer a vida do feto sobre a autonomia materna. Apesar da política atual de colocação da mulher grávida no centro da atenção à maternidade, as preocupações dos obstetras parecem estar mais relacionadas com o feto. Em outras palavras, parece haver um ponto em que o valor da vida fetal começa a superar, não tanto a vida da mulher, mas seu direito à autodeterminação, seus planos e suas escolhas. Embora seja importante reconhecer que essas cesáreas ordenadas por tribunais representam um extremo incomum dentro do cuidado da maternidade contemporânea neste país, o fato de terem acontecido evidencia algumas das suposições estereotipadas sobre as mulheres. Essas são suposições que fundamentam grande parte da prática médica atual e podem comprometer ou enfraquecer as mulheres de outras formas durante sua experiência de gravidez e trabalho de parto. Usando o primeiro e o último dos seis casos relatados como ilustrações contextuais, este artigo enfoca a interação complexa de processos que trouxeram a profissão médica para uma posição na qual sua própria convicção e determinação de fazer o que eles acreditam ser o melhor para a sua os pacientes resultaram em negação grosseira da autonomia das mulheres e o uso da lei para anular a recusa de consentimento das mulheres grávidas.

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Argument (English):

Argumento (português):

Keywords :

➡ c-section/caesarean ; law ; risk of litigation ; deontology ; obstetric and gynecologic violence obstetric violence, obstetrical violence

Author of this record :

Alison Passieux — 11 Jul 2018
➡ latest update : Bernard Bel — 11 Jul 2018

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