When “should not” becomes “must not” — how mandatory compliance with guidelines can threaten professional independence
There is a proliferation of rules and red tape at all levels of society. In New South Wales, for example, the Department of Health has been generating around 70–100 policy directives a year. Among other things, such directives tell obstetricians when and how to deliver babies — compliance is mandatory, under threat of disciplinary action and loss of indemnity cover.
The full article is accessible to AMA members and paid subscribers. Login to read more or purchase a subscription now.
Please note: institutional and Research4Life access to the MJA is now provided through Wiley Online Library.
- 1. New South Wales Health. Maternity — towards normal birth in NSW. Policy directive PD2010_045. Sydney: NSW Health, 2010. http://www.health.nsw.gov.au/policies/pd/2010/PD2010_045.html (accessed Sep 2011).
- 2. New South Wales Health. Maternity — timing of elective or pre-labour caesarean section. Policy directive PD2007_024. Sydney: NSW Health, 2007. http://www.health.nsw.gov.au/policies/pd/2007/PD2007_024.html (accessed Sep 2011).
- 3. National Institute for Health and Clinical Excellence. Caesarean section: quick reference guide. London: NICE, 2004. http://guidance.nice.org.uk/CG13/QuickRefGuide/pdf/English (accessed Sep 2011; no longer available).
- 4. Royal Australian and New Zealand College of Obstetricians and Gynaecologists. Timing of elective caesarean section. College statement C-Obs 23. Melbourne: RANZCOG, 2009. http://www.ranzcog.edu.au/component/content/article/503-c-obs/436-timing-of-elective-caesarean-section-c-obs-23.html (accessed Sep 2011).
- 5. Fisk N, Paterson Brown S. The safest method of birth is by caesarean. The Observer (London) 2004; 1 May: 18. http://www.guardian.co.uk/society/2004/may/02/health.politics1 (accessed Jan 2012).
- 6. Vashevnik S, Walker S, Permezel M. Stillbirths and neonatal deaths in appropriate, small and large birthweight for gestational age fetuses. Aust N Z J Obstet Gynaecol 2007; 47: 302-306.
- 7. Cotzias CS, Paterson-Brown S, Fisk NM. Prospective risk of unexplained stillbirth in singleton pregnancies at term: population based analysis. BMJ 1999; 319: 287-288.
- 8. Dietz HP. To mesh or not to mesh. Aust N Z J Obstet Gynaecol 2009; 49: 344-345.
- 9. Hannah ME, Hannah, WJ, Hewson SA, et al; Term Breech Trial Collaborative Group. Planned caesarean section versus planned vaginal birth for breech presentation at term: a randomised multicentre trial. Lancet 2000; 356: 1375-1383.
- 10. Jaynes ET. Probability theory: the logic of science. Cambridge: Cambridge University Press, 2003: 86-90.
- 11. Taper ML, Lele SR, editors. The nature of scientific evidence. Chicago: University of Chicago Press, 2004: 12.
- 12. Pearl J. Probabilistic reasoning in intelligent systems: networks of plausible inference. San Francisco: Morgan Kaufman, 1988: 33.
- 13. Ghosh JK, Delampady M, Samanta T. An introduction to Bayesian analysis: theory and methods. New York: Springer Science and Business Media, 2006: 31.
- 14. McGrayne SB. The theory that would not die: how Bayes' rule cracked the enigma code, hunted down Russian submarines, and emerged triumphant from two centuries of controversy. New Haven, Conn: Yale University Press, 2011.
No relevant disclosures.