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Defensive medicine during hospital obstetrical care: a by-product of the technological age

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  • Bassett, Ken L.
  • Iyer, Nitya
  • Kazanjian, Arminee

Abstract

This paper presents an alternative perspective on defensive medicine. Defensive medicine is usually understood as arising from the effect of law on medicine through fear of litigation. Of equal significance, however, is the complementary influence of medicine on law through technological innovation, and, more importantly, the way that medicine and law develop dialectically. Each shapes the other in establishing the standards of care central to both clinical medicine and to actual or potential legal action. Excessive testing owing to fear of litigation indicates that defensive medicine is being practised in a particular setting, but it does not explain why this is so. To understand why defensive medicine occurs and why it is so troubling to clinicians requires an understanding, not only of medical and legal developments, but of a political-economic system and the beliefs and values of a society. Defensive medicine is discussed in relation to hospital obstetrical scenarios commonly associated with fear of litigation: fetal oxygen deprivation ("distress"), which is detected using an electronic fetal monitor, and prolonged labor, known as "dystocia". The material presented is taken from a medical anthropological study of obstetrical care in rural British Columbia, Canada. Litigation fears are shown to result less from rare, albeit often devastating, allegations of malpractice than from doctors adopting a role as "fetal champions", together with the introduction of electronic monitoring technology. The paper concludes by asserting that, rather than being in an adversarial relationship, medical practice and associated litigation primarily work together to reinforce each other, and the social conditions in which defensive medicine occurs.

Suggested Citation

  • Bassett, Ken L. & Iyer, Nitya & Kazanjian, Arminee, 2000. "Defensive medicine during hospital obstetrical care: a by-product of the technological age," Social Science & Medicine, Elsevier, vol. 51(4), pages 523-537, August.
  • Handle: RePEc:eee:socmed:v:51:y:2000:i:4:p:523-537
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    Cited by:

    1. Lilly, Anna-Grace & Newman, Isabelle P. & Bjork-James, Sophie, 2024. "Our hands are tied: abortion bans and hesitant medicine," Social Science & Medicine, Elsevier, vol. 350(C).
    2. Beomsoo Kim, 2007. "The Impact of Malpractice Risk on the Use of Obstetrics Procedures," The Journal of Legal Studies, University of Chicago Press, vol. 36(S2), pages 79-119, June.
    3. Tully, Kristin P. & Ball, Helen L., 2013. "Misrecognition of need: Women's experiences of and explanations for undergoing cesarean delivery," Social Science & Medicine, Elsevier, vol. 85(C), pages 103-111.
    4. Roth, Louise Marie, 2023. "Defensive versus evidence-based medical technology: Liability risk and electronic fetal monitoring in low-risk births," Social Science & Medicine, Elsevier, vol. 317(C).
    5. Livio Garattini & Anna Padula, 2020. "Defensive medicine in Europe: a ‘full circle’?," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 21(2), pages 165-170, March.
    6. Livio Garattini & Anna Padula, 2020. "Defensive medicine in Europe: a ‘full circle’?," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 21(4), pages 477-482, June.
    7. Simmons, Rebecca K. & Singh, Gita & Maconochie, Noreen & Doyle, Pat & Green, Judith, 2006. "Experience of miscarriage in the UK: Qualitative findings from the National Women's Health Study," Social Science & Medicine, Elsevier, vol. 63(7), pages 1934-1946, October.
    8. Smith-Oka, Vania, 2022. "Cutting Women: Unnecessary cesareans as iatrogenesis and obstetric violence," Social Science & Medicine, Elsevier, vol. 296(C).
    9. Julie Prowse & Peter Prowse, 2008. "Role redesign in the National Health Service," Work, Employment & Society, British Sociological Association, vol. 22(4), pages 695-712, December.

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