The principle of respect for patient autonomy supports a pregnant woman's rights to refuse recommended medical treatments, even if such refusal may be detrimental to her or to her fetus. The incidence of cesarean delivery without medical or obstetrical indications is increasing in the US, one component of which is cesarean deliveries at maternal request (CDMR). Principles of beneficence and nonmaleficence are particularly challenging with CDMR, since they must balance benefits and harms for both mother and baby in a situation where there is a lack of reliable authoritative data, physicians' own personal views may vary widely, and there is heated political as well as medical debate. The anesthesiologist probably would not have been directly involved in the patient's and obstetrician's decisions regarding mode of delivery. When patients request unnecessary interventions, additional ethical considerations include issues of distributive justice.