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# Maternal-fetal conflicts: refusing a caesarean

- Topic

When a capable pregnant woman refuses a caesarean recommended for the fetus, the team talks with her but does not force her.

Updated Nov 13, 2026

## Key points

- A capable, informed pregnant woman decides about her body, even if her decision raises the risk to the fetus.
- US professional societies condemn coercion; a court order is a last resort that is almost never justified.
- First: understand the reasons (fear, past experiences, beliefs, costs, misunderstandings).
- Law 1751 of 2015, art. 10(d): no one may be forced to receive treatment against their will.
- Law 2244 of 2022, art. 5: the woman states her informed refusal or dissent in writing.
- The reverse case counts too: refusing without reasons a caesarean requested with information was obstetric violence (T-058 of 2026).

## What it is

A maternal-fetal conflict arises when a pregnant woman refuses a test or treatment, such as a caesarean, that the team considers necessary for the fetus's wellbeing. It sets respect for the woman's autonomy and bodily integrity against the wish to protect the fetus. US professional societies (in obstetrics, paediatrics and medicine) agree that education and dialogue are the main route, condemn coercion and consider that going to court is almost never justified. In Colombia, no one may be forced to receive treatment against their will (Law 1751 of 2015, art. 10), and Law 2244 of 2022 recognises the pregnant woman's right to state her informed dissent in writing. Many apparent conflicts are resolved by understanding the woman's reasons.

## Structure

- Autonomy-centred position: the woman is the only patient with rights; the fetus is protected through her decisions.
- «Fetus as patient» position: the physician has beneficence-based duties to the viable fetus, met through firm recommendations, but not through force.
- Arguments against court orders: the process is slow, the fetal prognosis is often uncertain, it breaks trust and may drive other pregnant women away from care.
- Minority argument for intervening: exceptional cases of serious, irreversible harm to the fetus with low risk to the woman.

## Step by step

- Explain clearly the risk to the fetus and to the woman, with honest figures and no exaggeration.
- Ask about and listen to the reasons for refusal; look for misunderstandings, fears or past experiences.
- Assess decision-making capacity; if in doubt, ask for a formal evaluation.
- Offer alternatives acceptable to her and check whether the recommendation can be adapted.
- Involve people she trusts if she wishes, and an interpreter or social worker when needed.
- Ask the clinical ethics committee for support if the disagreement persists.
- If she maintains the refusal, respect it, document the information given and her written dissent, and keep providing the rest of her care.

## In clinical practice

- Repeat the conversation if the clinical situation changes; an earlier refusal does not prevent offering the caesarean again.
- Never threaten to report her, withdraw care or go to court to pressure her decision.
- After the birth, review the case with the team without blaming the patient.

## Legal framework in Colombia

- Statutory Law 1751 of 2015, art. 10(d): the right to an informed decision; no one may be forced to receive treatment against their will.
- Law 2244 of 2022, art. 5 (informed dissent in writing) and art. 4 no. 23 (humanised caesarean).
- Ruling T-058 of 2026: putting barriers to a caesarean requested freely and with information violated the pregnant woman's autonomy.
- No Colombian rule authorising a caesarean to be imposed on a capable pregnant woman who refuses it was found on official sites. Texts checked on 2026-11-13.

## Test yourself

Think of the answer, then tap the question to see it.

## What ethical conflict does refusing a caesarean recommended for fetal distress raise?

Respect for the woman's autonomy and bodily integrity versus the wish to protect the fetus.

## What do US professional societies say about seeking a court order for a caesarean?

That coercion is not acceptable and that going to the legal system is almost never justified; they recommend dialogue and the ethics committee.

## Which Colombian law states that no one may be forced to receive treatment against their will?

Statutory Law 1751 of 2015, art. 10(d).

## What should the team do if a capable pregnant woman keeps refusing after being informed?

Respect it, document the information and her written dissent, and keep caring for her, offering the intervention again if conditions change.

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## Connections

## Related 5

- [Refusing treatment, including blood transfusion](https://durgical.com/en/medical-ethics/refusing-treatment-including-blood-transfusion/)
- [Law 2244 of 2022: dignified childbirth and obstetric violence](https://durgical.com/en/medical-ethics/law-2244-of-2022-dignified-childbirth-and-obstetric-violence/)
- [Decision-making capacity (competence) and how to assess it](https://durgical.com/en/medical-ethics/decision-making-capacity-and-how-to-assess-it/)
- [Hospital ethics committees and ethics consultation: Resolution 13437 of 1991 and Resolution 813 of 2026](https://durgical.com/en/medical-ethics/hospital-ethics-committees-and-ethics-consultation-resolution-13437-of-1991-and/)
- [Moral status: who counts, the five theories and degrees](https://durgical.com/en/medical-ethics/moral-status-who-counts-the-five-theories-and-degrees/)

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Educational content on ethics and health law; not legal advice. Laws and case law change: each page links the official text and says when it was last checked. For a real case, read the text in force and ask a lawyer or the medical ethics tribunal.

Sources: [Management of Pregnant Patients Who Refuse Medically Indicated Cesarean Delivery (Reviews in Obstetrics and Gynecology, 5:e144)](https://pmc.ncbi.nlm.nih.gov/articles/PMC3594862/) (PubMed Central, 2012); [The prevention and elimination of disrespect and abuse during facility-based childbirth](https://www.who.int/publications/i/item/WHO-RHR-14.23) (World Health Organization, 2014); [Ley Estatutaria 1751 de 2015, que regula el derecho fundamental a la salud](https://www.funcionpublica.gov.co/eva/gestornormativo/norma.php?i=60733) (Función Pública, Gestor Normativo, 2015); [Sentencia T-058 de 2026](https://www.corteconstitucional.gov.co/relatoria/2026/T-058-26.htm) (Corte Constitucional de Colombia, 2026).

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License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/medical-ethics/maternal-fetal-conflicts-refusing-a-caesarean/