Autonomy vs. the environment: nitrous oxide use in obstetrics, an ongoing challenge

Abstract

We read with interest the editorial by Lucas et al. [1] discussing the use of nitrous oxide (N 2 O) catalytic cracking to reduce the occupational exposure and environmental impact of N 2 O use in healthcare. We would like to draw attention to the framing of information, the consideration of public health 'nudges' and patient autonomy in healthcare, particularly within obstetrics.Women's rights to patient-centred care and decisionmaking are set out in common laws across Europe and are supported by the World Health Organization. Previous studies

Anaesthetic subspecialties and sustainable healthcare: a narrative review

“…Simply denying the option of inhalational analgesia to women in labour is unethical, especially in locations such as home-birthing and standalone midwifery units where alternative analgesia is not readily available [21].…”

“…Despite the lack of high‐quality evidence of its consistent analgesic effects, nitrous oxide is the most common analgesic used in maternity services in the UK [19] and has been globally accepted in clinical practice [20]. Simply denying the option of inhalational analgesia to women in labour is unethical, especially in locations such as home‐birthing and standalone midwifery units where alternative analgesia is not readily available [21].…”

On the ethics of removing Entonox® from labour ward: beyond carbon dioxide equivalents and seeking justice for patients and the planet

“…Other strategies, including nitrous oxide cracking technology, have potential to reduce impact further. Murphy et al described how to address removal of Entonox: highlighting the importance of patient involvement; and provision of adequate unbiased information on environmental impact, to enable patient autonomy and facilitate shared decision-making for analgesic options [18].…”