Re: Informed Refusal - VBAC
From: zygote@icsi.net
Wed Mar 15 16:14:26 2006
The syntax below is lovely and on point!!!
On 15 Mar 2006 at 13:08, Dr. Ainsworth wrote:
> Informed refusal is inextricably intertwined with the process of
> informed consent. After addressing the risks, benefits, and
> alternatives of a proposed medical treatment, surgical procedure, or
> diagnostic test, an explanation of the risks of refusing or declining
> the proposed intervention also must be given; this should be considered
> a fourth element of the consent process. Just as a patient has the
> right to consent to treatment, she may choose to refuse treatment.
> Patients are entitled to participate with their physicians in a process
> of shared decision making.
>
> Informed consent laws have evolved from the relatively paternalistic
> "professional or reasonable physician" standard to the "materiality or
> patient viewpoint" standard. In the professional or reasonable
> physician standard, a physician must disclose to a patient the risks and
> benefits that are customarily disclosed by the medical community for
> that medical treatment, surgical procedure, or diagnostic test. In the
> materiality or patient viewpoint standard, a physician must disclose to
> the patient the risks, benefits, and alternatives that a reasonable
> person in the patient's position would want to know to make an informed
> decision. In making such disclosure, a physician also must make
> allowance for the patient's level of health literacy and cultural
> background. It often is helpful, for example, to ask the patient to
> explain in her own words her understanding of the essential elements of
> this patient–physician exchange of information. As is frequently
> emphasized, informed consent is a process and not a mere document.
>
> The above is from the recent ACOG Committee Opinion on Informed Refusal.
> How does that relate to our discussion on the availability of VBAC in a
> small hospital? If we tell the patient that we do not have the
> recommended capability for immediate availability ... yada...yada, and
> they signed an informed refusal for repeat cesarean section, how
> effectively would that protect us from the lawyers in case of a bad
> outcome? I know many of you would say, if the patient refuses a C/S,
> discharge her from your practice and send her somewhere else. However,
> in rural locales, there are no suitable alternatives and "St. Elsewhere"
> is over an hour and a half away. I also don't think patient refusal of
> recommended care is always a reason to discharge a patient. We
> sometimes have to agree to disagree.
>
Robert J. Carpenter, Jr. MD
6624 Fannin, #2720
Houston, TX 77030
(O) 713-795-4600
(F) 713-795-4422
"Life is difficult"
The Road Less Travelled
by Scott Peck
