Medical Aspects, Professionalism, and Bioethics of Anesthesia in Cesarean Section on Self-Request

Authors: Nasrudin Andi Mappaware, Muh. Wirawan Harahap, Erlin Syahril, Farah Ekawati Mulyadi, Susdiaman

Abstract:

The increasing trend of cesarean sections, especially those performed on self-request without medical indications, presents complex dilemmas related to medical aspects, professionalism, and bioethics. This study aims to investigate the medical, professional, and bioethical considerations surrounding anesthesia in cesarean sections performed on self-request without medical indications. We report the case of a 27-year-old woman, G1P0A0 gravid 38 weeks, admitted to the hospital for a planned cesarean section on request for the reason that she could not tolerate pain and requested on a date that corresponded to the date and month of her mother's birth. Cesarean section on patient request fulfills the principle of autonomy, which states that patients have the right to themselves. However, this medical procedure is still considered no safer and riskier even though medical technology has developed rapidly. Furthermore, anesthesia during cesarean section at self-request without medical indications is a dilemma for anesthesiologists considering the risks and complications of anesthesia for both the fetus and the mother. The trend in increasing the number of cesarean sections is influenced by patient reasons such as not being able to tolerate pain, trust factors, and worry about damage to the birth canal.

Keywords: Anesthesia, bioethics, cesarean section, self-request, professionalism.

References:

[1] Cunningham, F G. Gant, N F. Leveno, K J. Gilstrap III, L C. Hauth, J C. Wenstrom, K D. 2012. Obstetri Williams. Edisi 23. Vol.1. Jakarta: EGC.
[2] Wiknjosastro, H. 2010. Ilmu Kebidanan Sarwono Prawirohardjo. Edisi keempat cetakan ketiga. PT Bina Pustaka Sarwono Prawirohardjo. Jakarta. Kounteya,s 2010
[3] Marlina. 2016. Faktor Persalinan Secsio Caesarea di Rumah Sakit Imanuel Bandar Lampung. Jurnal Kesehatan Politeknik Kesehatan Tanjung Karang. Vol 7, No1.
[4] Kementrian Kesehatan RI. 2018. Hasil Utama RISKESDAS 2018. Badan Penelitian dan Pengembangan Kesehatan. Hal 173-184.
[5] Jitowiyono, S dan Kristiyanasari, W. 2012. Asuhan Keperawatan Post Operasi Dengan Pendekatan Nanda, NIC, NOC. Yogyakarta: Nuha Medika.
[6] Cunningham, F G. Gant, N F. Leveno, K J. Gilstrap III, L C. Hauth, J C. Wenstrom, K D. 2014. Obstetri Williams. Edisi 23. Vol.1. Jakarta: EGC.
[7] Prawirohardjo, S (2010). Ilmu bedah kebidanan. Jakarta: PT Bina Pustaka
[8] Bowden M, Brake A, Crombie R et al. Patients’ recall of information given during the process of obtaining consent for regional anaesthesia. Int J Obstet Anaesth 2001; 10(3): 238.
[9] Salfariani, I & Siti, S.N (2011). Faktor Pemilihan Persalinan Sectio Caesarea Tanpa Indikasi Medis Di RSU Bunda Thamrin Medan. Universitas Samatera Utara: Jurnal Hasil Riset. http://www.e-jurnal.com/2014/10/faktor-pemilihan-persalinan-sectio.html
[10] Mochtar, Rustam. 2012. Sinopsis Obstetri: Obstetri Fisiologi, Obstetri Patologi Rustam Mochtar Edisi 3 Jilid 1. Jakara:EGC.
[11] Ayuningtyas, D, Ratih, O, Misnaniarti, Nyoman, DS. 2018. Etika Kesehatan pada Persalinan Melalui Sectio Caesarea Tanpa Indikasi Medis. Jurnal Media Kesehatan Masyarakat Indonesia. Vol4, No.1.
[12] Latham SR, Norwitz ER. Ethics and “cesarean delivery on maternal demand”. InSeminars in perinatology 2009 Dec 1 (Vol. 33, No. 6, pp. 405-409). WB Saunders.
[13] Stern, D.T. (2006). The humanism curriculum and professional development. The Journal of Medical Education, 81(9), 797-804. https://doi.org/10.1097/00001888-200609000-00008
[14] Dewan Pertimbangan Perkumpulan Obstetri dan Ginekologi Indonesia. Panduan Etik dan Profesionalisma Obstetri dan Ginekologi di Indonesia. 2017.
[15] Sumastri, Heni, et al. "Determination of Caesarean Section (SC) Delivery." Jurnal Multidisiplin Madani, 2024, https://doi.org/10.55927/mudima.v4i4.8948.