The response from Swan to my article is appreciated. I find concerning the insights on how third-party managed care might have an adverse impact on patient rights and good medical practice. For example, Swan infers that subtotal compliance with antibiotic guidelines for caesarean deliveries is a quality concern. In scheduled caesarean deliveries, 100 patients must receive prophylactic antibiotics to avoid one infection-related complication.1 Material risks, such as anaphylaxis, plus uncertain consequences for the infant, must be disclosed. Accordingly, respect for informed decision making by mothers-to-be might better explain and justify a ceiling to guide uptake.
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