Conformed Consent

One of the most frustrating things for doulas and childbirth educators is that our clients are rarely given true informed consent when it comes to healthcare decisions for moms or newborns. As a childbirth educator, I talk about it in class all the time - telling my students they deserve informed consent in pregnancy and birth and have a right to expect it from their healthcare teams.

But what does informed consent mean in most hospital obstetrics settings in Kansas City? Very little, actually. More often than not, doctors and nurses tell my doula clients that a procedure (such as an epidural, amniotomy, or even vaginal exam) is risk-free, when the preponderance of evidence tells us otherwise. Women are given consent forms to sign before receiving epidural anesthesia, but rarely do moms take the time to read the lengthy forms and understand all of the epidural's risks. And other procedures, considered part of the normal obstetrics package, don't require separate consent and the information consent forms provide.

As a childbirth educator and doula, I tend to view informed consent from the parents' perspective. But healthcare providers traditionally aren't thinking of their patients when they think of informed consent; the value to them is that informed consent should provide legal protection if something goes wrong. But are hospitals and physicians truly protected if patients aren't informed?

Glenn McGee, editor-in-chief of the American Journal of Bioethics,  was quoted today in the American Medical News on the subject: "... the problem in informed consent right now is that it is the most impersonalized medicine there is ... Everything that could be wrong with informed consent is wrong."


McGee is absolutely right. 

So I'll be carefully watching the PREDICT program, the initiative McGee discussed with American Medical News. PREDICT, which provides an informed consent protocol to which doctors and hospitals can conform, is testing the effectiveness of true informed consent in non-emergent cardiac procedures. The program, which was developed at St Luke's Hospital in Kansas City (one of my two favorite natural childbirth hospitals in the area), is spreading to pilot hospitals across the US.  Under this paradigm, doctors will draw on a national database to individualize risk factors for each patient. Informed consent discussions will go beyond "1 in 200,000 patients risk this side affect" to "Your chance of suffering this side affect is (X) percent," to the degree that information is available.

PREDICT's kind of informed consent will truly allow patients (or at least, those who want to know) to make quality decisions about their health care. Patients who have an active role in the decision-making process have better long-term outcomes, studies suggest.  (For an interesting look at the long-term benefits of being involved in healthcare decisions, look at Journalist Thomas Goetz' book The Decision Tree: Taking Control of Your Health in the New Era of Personalized Medicine).

Bioethicist McGee predicts this paradigm will rapidly shift to other areas of medicine. I'm hoping he's right. Hospitals and physicians need to conform to expanded informed consent rationale - training doctors and nurses in the art of educating patients, and ultimately putting the patient's best interests above the fear of getting sued.