When Doctors Lie: Obstetrics and Informed Consent
By Danell Swim
January 21, 2008
The American Medical Association has guidelines for discussing these procedures with a patient before consent can be given: it is called Informed Consent. These topics cannot be disclosed by a representative, such as a nurse, but only from the doctor alone.
#1: Discuss the patient’s diagnosis, if known;
In the case of obstetrics, this could be evaluating the time in labor, the position of the baby, the general health and well being of the mother and baby, and any other pertinent information that would be instrumental in making an informed decision.
#2: The nature and purpose of a proposed treatment or procedure;
#3: The risks and benefits of a proposed procedure;
This is the part where most doctors fail to comply. Explaining the risks of a procedure can be daunting. When the doctor feels that a cesarean is best, but has to mention things like: maternal hemorrhage, embolism, hysterectomy, infection, reactions to anesthesia, and death; and risks to the fetus are equally alarming: increased risk of neonatal intensive care unit, fetal injury, immature lung development, infection and death. It can make the situation problematic for receiving consent from the patient.
#4: Alternatives (regardless of their cost or the extent to which the treatment options are covered by health insurance)
Alternatives to cesarean may include augmenting labor with Pitocin, allowing the mother to labor in other positions which may increase pressure on the cervix, thus further dilating it, or natural forms of augmentation (nipple stimulation, submersion in water, or walking).
#5: The risks and benefits of the alternative treatment and procedure
#6: The risks and benefits of not receiving or undergoing a treatment or procedure
And, the patient should be given ample opportunity to ask questions so that they may better understand their diagnosis, and any proposed treatments or procedures.
This strict set of guidelines is in place so that patients can be informed, and in control of their own health. The AMA sees Informed Consent as an ethical obligation, as well as a legal requirement.
How often are these guidelines violated? Every single day, in every hospital across
You can see it for yourself if you watch any of the ‘birth’ shows on The Learning Channel or Discovery Health, if you talk to women who have had babies, or if you’re unfortunate enough to have had one of these doctors for yourself.
Every day I see more cases of doctors failing to inform patients of any risks associated with procedures. Instead, they are told that these treatments are “perfectly safe.”
There is no perfectly safe procedure known to the medical profession. One simply does not exist. If it goes into your body or touches you, it has risks associated with it. The same is true of epidurals, induction of labor, cesareans, episiotomies and countless other ‘routine’ interventions.
When doctors tell their patients that the epidural is just a routine, non-invasive, safe procedure that is done everyday, they are violating their oaths as doctors, and doing a great injustice to the patient. It benefits no one when doctors boldly lie to coerce patients into these proposed treatments. Educating the patient on any planned procedures is the only ethical, logical and legal recourse, and should be standard practice.
Unfortunately, few doctors abide by these strict rules, and no one is held accountable. It is up to the patients to direct any discussions on treatments to include the six steps outlined by the AMA. The patient should be asking about their own health, the risks associated with the treatment the doctor proposes, and all other alternatives. If the doctor refuses to comply, or simply says that the intervention is “safe,” you know that they are lying, and unsuitable as your physician. It is then time to find another doctor. Hopefully, one that follows the ethical standards of their profession.
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