Electronic Fetal Monitoring, Cerebral Palsy Litigation, and Bioethics: The Evils in Pandora’s Box

Abstract

Pandora opened the box releasing death and all other evils into the world. She hastened to close the lid but the whole content had escaped except for one thing at the bottom of the box -HOPE. Paraphrase of the Greek Myth in Hesiod's Works and Days.Edward Hon opened the Electronic Fetal Monitoring (EFM) Pandora's Box in the 1950s. Although perhaps noble in original purpose, the unintended EFM consequences over the last half century resulted in more harm than good to mothers and babies in most of the industrialized world. EFM became the standard of care not because it was scientifically efficacious, but because it was promoted by physicians with undisclosed conflicts of interests and because obstetricians desperately wanted to believe that a machine would solve the age old cerebral palsy malady and at the same time protect physicians and hospitals from the then new and costly cerebral palsy birth injury lawsuits. EFM became the standard of care at the same time that bioethics became medical reality replacing the medical profession's Hippocratic paternalistic ethic with patient autonomy and informed consent in virtually all aspects of medical practice except for the use of EFM. The use of EFM without informed consent has continued for fifty years with no outcry from the bioethical world. This article explores this ongoing medical and ethical calamity, and discusses why even today EFM use continues disguised as a safety device when in fact its use is primarily as protection for physicians and hospitals from cerebral palsy lawsuits.