Informed Consent - All Yeses are NOT Created Equal

Today Jaelin and Andie talk about the importance of informed consent and what that means for your healthcare.

Points from the Midwife Monday Video:

The people spoke, and they cried out for more information on informed consent.

Now it’s time to get the message out that it is right to demand true and proper informed consent from your provider. Not only is informed consent a legal issue, but it is an ethical one too. You have the right to say “Yes” or “No” to anything and everything you want. Your “Yes” or “No” does not have to be made until you have received enough information and asked all your questions.

This is another reason we love being midwives. Because we keep a light clientele load, we have afforded ourselves and you the luxury of time. We spend an hour at every visit to make sure decision making is informed. It truly is a trusting partnership built on communication that in turn fosters the shared decision making model we adore.

All Yeses are not created equal. When decisions are made with confusion or lack of information, it is illegal and unethical. So, let’s think about those aspects.

Ethically, informed consent is needed to value and protect a person’s autonomy. This is a fancy way of saying you get to make your own decisions. Informed consent protects your rights as a human being. As an individual, you own the freedom to make decisions for yourself about tests, screens, procedures, and surgeries based on every bit of information available. More so, NO ONE has the right to coerce you into a decision based on misinformation or fear based tactics.

Flip side of the coin is legality. Not only do you have a right to informed consent, but no one else has a right to touch you without your approval.I’d say procedures and surgeries include touching. If this occurs, it is classified as battery.

I don’t want to linger here long because I don’t feel I agree, but the medical model defines consent in two ways…

Implied and Expressed Consent.

By simply walking into a doctor’s office it is implied that you have given consent to have a physical exam. I don’t like that. Someone should always ask.

Expressed consent is either written or said consent to have an exam.

What makes it truly informed? All the information is laid out. It is given in a non-scientific, non-medical way, so the client understands, and the information is in their language. That information should include

·    The condition or problem that the client is having

·    Is there a need for more testing?

·    Natural course of the condition and possible complications

·    What happens if we do nothing?

·    What are the treatment options?

·    What are the risks? How about the benefits?

·    What are the financial obligations and the time obligations?

·    What could they expect the outcome to be?

·    And what comes next as far as follow ups?

There should always be time for clarification and questions. Not only do you have the freedom to voluntarily give consent when you are ready, but you can revoke that consent at any time.

“Don’t touch me.” “Stop that now.” “I changed my mind.”

If you have given your consent in a fog of fear or intimidation, that consent is not valid anyway.  I don’t want to discuss this portion, but if you want to gag in your mouth a little, go look up therapeutic privilege. It’s disgusting, and just so you know, Jaelin and I (Andie) would never do use therapeutic privilege.

Just as you have a right to informed consent, you have a right to informed refusal. You are not a bad parent or client if you refuse something. It means you have done your thinking and that’s what you decided. Your provider should support you. The phrase that comes to mind most is “Discharge against medical advice”. They make it sound so scary.  It’s okay. You make the choices. You are the CEO and captain.

I know we have listeners all over the world, so laws may differ where you are. However, most countries, and definitely here in America, there are regulations, federal acts and professional guidelines that clearly dictate that every pregnant woman has the right to base her maternity care decisions on accurate, up-to-date, comprehensible information. Despite these efforts, evidence suggests that informed consent within current health-care practice is restricted and inconsistently implemented. Patient access to evidence-based research is imperative under the scope of informed consent and is particularly important during a time when perinatal mortality and morbidity rates, interventions, and disparities are on the rise in the United States.

This article describes the Coalition for Improving Maternity Services’ investigation of the breakdown of informed consent in maternity care.

Every pregnant woman has the right to “base her maternity care decisions on accurate, up-to-date, comprehensible information”.

Some History on Informed Consent

We can’t really appreciate where we are today unless we peek at where we came from and what brought us here. Our medical system is based on a model that is paternalism. One where doctors had authority about ALL. People were objects, and doctors are experts. That model went on for hundreds of years. I may be biased, but I do believe we still marinate in that paternalistic model a bit.

Remember that fancy word from earlier? Autonomy. That wasn’t even considered until 1914! There was a famous court case where a doctor decided he wanted to remove a woman’s fibroids while she was under anesthesia to be examined. She won the case filed against him, and now consent is mandatory. Informed consent, though, is a whole other barrel of monkeys.

Because we deal with pregnancy quite a bit, informed consent takes on a whole new complexity. Decisions are being made for two or more people now. Every single choice should be made based off of evidence based information with thought given to holistic health, beliefs, preferences, and values. Look at the risks, the benefits, and the “what will we do with that information if we got it?”.

We all should be growing in knowledge of the evidence that points at the numerous risks associated with the over use of interventions. Over a million moms had surgical births this year. Over 70% had an epidural, almost 50% had Pitocin, and over 50% had a catheter. Nearly 100% had repetitive cervical exams. I have to pause and wonder if each of those decisions were marked with true informed consent.

Research shows that when a woman is included in informed decision making, there is an impact on her babies’ health, and those same women were able to self report more positivity about their experience and their baby.

Informed consent is about empowerment.

Andie WyrickComment