An ethically justified algorithm for offering, recommending, and performing cesarean delivery and its application in managed care practice

When cesarean delivery is substantively supported and vaginal delivery is not supported in beneficence-based clinical judgement, the physician should offer and recommend only cesarian delivery. When both cesarian and vaginal delivery are substantively supported in beneficence-based clinical judgment, the physician should offer both, discuss and controversy, and make a recommendation. When cesarean delivery is supported and vaginal delivery is more substantively supported in beneficence-based clinical judgment, the physician should offer both and recommend vaginal delivery. If cesarean delivery is not supported and vaginal delivery is substantively supported in beneficence-based clinical judgment, the physician should offer only vaginal delivery. When cesarian delivery is requested and well supported solely in autonomy-based clinical judgment, the physician should repeat the recommendation for vaginal delivery and either perform cesarian delivery or make a referral. Physicians may use this algorithm in negotiating managed care contracts.