Re: Elective Induction - something goes wrong
From: Efrain Ramirez (eramirezt@coqui.net)
Sun Jul 11 15:28:21 2004
Garry has a very good one - we use it - once in a while - should use
evry time --
>At Sun, 11 Jul 2004, Larry Glazerman wrote:
>
>Joe:
>
>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.
>
>I'm interested in others' thoughts.
>
>--
>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.
>
--
"The opposite of a correct statement is a false statement.
But the opposite of a profound truth may well be another profound truth."
Niels Bohr (1885 - 1962)
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