That brings up an interesting question that I've raised several times here
and in my hospital. Our hospital requires a consent form (I know very well
that informed consent is a process, not a piece of paper) for every patient
admitted for vaginal delivery. I've always been of the opinion that one
can't consent to something you can't refuse. If the patient doesn't sign the
consent, what are the options? She will still deliver.
The argument used is the possible need for interventions such as forceps,
vacuum, C-section, etc., and the further argument that informed consent
can't be given under duress, i.e. labor.
--
Larry R. Glazerman, MD
Ob-Gyn at Trexlertown, PC
610-402-0161
l.glazerman@rcn.com
_____
From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of
DoctorJoe@aol.com
Sent: Sunday, July 11, 2004 11:39 AM
To: Multiple recipients of list OB-GYN-L
Subject: Re: Elective Induction - something goes wrong
In a message dated 7/11/04 07:01:03, rbraun@iupui.edu writes:
And a total lack of doing anything. Starting an IV is harmful. Doing a
hysterectomy is harmful.
The principle should state: Do the least harm possible while doing the
most good.
Since this thread originated as a question of "What are your chances in
court?" or whatever, the comments above can be looked at in a legal sense.
Any medical "care" (IVs, C-section, even pelvic exams) are legally
technically a battery on a person. Battery is a harmful or noxious touching,
no more, no less. Sticking someone's arm with a needle or slashing their
belly open is clearly battery if you did it on the street. Easy concept.
In the medical setting, the thing that you, the physician or nurse, use to
DEFEND against this (potential) charge of battery with is CONSENT. You can
give your consent for someone to do something that ordinarily would
constitute battery and this is what the batterer uses to defend themselves
against liability. Otherwise, any running back who is smashed to the ground
by a 300 pound defensive lineman could cry "Battery!" and file charges. The
running back gave his CONSENT to be thrown to the ground. Just as your
patient gave CONSENT for you to stick her in the arm or slash her belly open
or whatever.
The CONSENT in the medical situation is now a rather elaborate mechanism
called INFORMED CONSENT. For a patient to give you consent for some
surgery/treatment/would-have-been-a-battery-in-normal-life/procedure, you
have to explain to them the procedure, the possible benefits, the materially
possible complications, and the available alternatives and THEIR
complicatons and benefits, etc. Thus, the PATIENT gets to give you consent
(or not) in an informed manner, so you have permission (defense of consent)
to do whatever procedure you want to do on them.
So what you do in your professional capacity is to evaluate the situation
(does she need an IV? does she need to be induced? does she need a
c-section? etc.) and give the patient your best professional opinion (and
the available options) and let her make an informed decision.
So what does "do no harm" mean? It's actually damned complicated, really.
The thing that complicates it is that you've (presumably) developed a
professional relationship with the patient and have a duty within that
relationship it treat them with appropriate skill and care (one La. statute
reads "Standards of medical malpractice require a physician to act with the
degree of skill and care ordinarily possessed by those in that same medical
speciality acting under the same or similar circumstances. Departure from
this prevailing standard of care, coupled with harm, may result in
professional malpractice liability.")
So the question is: does starting that IV (or that induction, or that
c-section) evidence the same degree of skill and care ordinarily possessed
by your fellows of the same specialty acting under the same or similar
circumstances? That's what your patient is essentially looking for in you.
If you DON'T do that, then you're looking for trouble.
Whew! Hope that's clear. . . .
Joe P.
