Re: vbac on demand

From: Henry Gregor (henrygregor@yahoo.com)
Sun May 25 10:19:59 2008

Wow, Steve, your post shook me loose from my prior resolve not to comment on this potentially never ending discussion. But your conjecture that a bad outcome will not lead to litigation in the event of a bad outcome if what the patient desired got done...whew!!...that just flies totally in the face of a mountain of factual litigation history re lawsuits over adverse VBAC outcomes. Those suits go to trial despite informed consent processes having been observed....(I'll conjecture at this point that cases done without documentation of informed consent get settled before trial...will further conjecture that it would be difficult to find VBAC's being done in today's USA medical-legal climate without informed consent.) So, your sanguine view that doing what the patient wants will insulate one from litigation seems a bit misguided, IMHO, no flame intended, whatsoever.

Hank Raymond Stephen <Stephen.Raymond@dhhs.tas.gov.au> wrote: All of the concern about losing one's career and livelihood really applies in a different way when you are faced with a patient who doesn't want to accept your blanket policies. Is she more likely to sue you and win, if you do what she wants and she has a bad outcome, or is it more likely, if you don't do what she wants and has a different bad (to her) outcome. I would have thought that, given that most litigation arises out of a situation where a patient's expectations haven't been met, it is likely that the bad outcome that you predicted will not lead to litigation, if you do what she wants.

Steve

--------------------------------- From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of DoctorJoe@aol.com --------------------------------- Sent: Saturday, 24 May 2008 1:43 AM 

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To: Multiple recipients of list OB-GYN-L
Subject: Re: vbac on demand


In a message dated 5/23/08 9:54:06 AM, ajfields@pine-net.com writes:


  Would that be that the physician's right to do whatever he wants trumps
the patient's right to informed consent? Or that the physician's legal
and financial risk are more important than the patient's physical risk?
Because I really can't see how the relative risks aren't important to
this woman's decision about her body.


There are two "rights" here (if you ignore the baby's right):


1) The woman's right to take whatever risks with her body (after being informed what the risks are).


2) The physician's right to practice what he feels is good medicine (i.e. not be forced against his better judgment into a course of action that he feels is unacceptable, given the standards, the circumstances, etc.).


How you balance those two "rights" is the question.


We all talk of #1 a lot, as we should. But #1 does NOT automatically overrule #2, by any means.


And sometimes, although I may be getting ahead of the argument here, there is no easy solution to the problem and it ends up being decided on policy grounds (e.g. you can't have patients willy-nilly showing up at hospitals and demanding unacceptable procedures or treatments when the doctors don't think they're warranted -- it would make the "system" unworkable).


Joe P.




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