I was amazed to read about the cesarean section rate in this country and especially in Florida's Miami-Dade county in "Born in the USA" (AJN Reports, August). A rate of surgical births greater than 51% cannot be a medical necessity, by any stretch of the imagination.

"The Third Reich, Nursing, and AJN" appears in the same issue and led me to ponder nursing ethics in regard to these topics. Cesarean sections usually require the involvement of nurses. Are nurses refusing to participate in these surgical procedures, which can be deemed unethical because of the risk to both mother and infant? Are patients being provided with the latest research on this topic when they sign an informed consent form? I have read many times about nurses refusing to participate in abortions, but I've never heard about a nurse refusing to participate in an elective cesarean section-or even questioning one.

Delores Reagan, BSN, MA, retired

Tacoma, WA