We live in an age where personal choice is paramount, even for medical matters. But sometimes the balance of choice goes too far.
It is fairly common nowadays for women to request medical interventions that have questionable scientific basis, and sometimes completely unnecessary.
We all have heard of women who are ‘too posh to push’. They opt for unnecessary caesarean deliveries rather than going through vaginal deliveries.
Cosmetic vaginal surgery, hysterectomies, pre-term deliveries and all other types of interventions are commonly requested in gynaecology settings. The question that arises is whether clinicians are duty-bound to accede to such requests?
From the women’s viewpoint, choice must be respected. Women electing to have non-traditional medical interventions will usually have gone into great lengths to justify their requests.
They will often be based on sound reasoning, preference and values. But it is not unusual for some to request unreasonable interventions based on a fad. Examples are plenty, especially after so called celebrities undergo certain surgical procedures, which then catch on as the fancy thing to do.
Physicians have the right to decline your request, especially if based on a fad and without any scientific basis. The tenet of medicine is to avoid doing harm, offer cost-effective interventions and be aware of the impact of medical interventions on the wider healthcare system. You should, therefore, expect your gynaecologist not to simply accept your requests. They will go into reasonable lengths to explore the reasons behind your request, and offer you alternatives based on your specific circumstances.
Risks and benefits
The key to coming to a consensus is open communication, with shared decision making between you and your gynaecologist. All factors must be considered. Risks and benefits of the procedure must be discussed, including other reasonable factors that may be important to you. Such factors may sometimes be in direct conflict to prevailing medical practice. You must nevertheless be listened to, and helped to completely understand and question your choices.
Depending on the context, acceding to a request for an intervention that is not traditionally recommended can be ethically acceptable. This should always be guided by individual circumstances, and careful counselling. But insurance and hospital regulations may come in the way of certain requests. When this happens, your gynaecologist should still convey respect for your viewpoint and request, and express regret that it cannot be met.
In contrast, physicians will decline your request — based on scientific evidence — if acceding to such requests would be detrimental to your overall health and welfare. In such cases, physicians are not ethically obliged to refer you to a willing provider. But they may refer you for a second opinion, which is likely to be concordant to their own.