Excerpts ~ ACOG Committee Opinions 166 & 214 on “Informed Refusal” & the “Patient Autonomy: The Maternal-Fetal Relationship” 

by faithgibson on May 22, 2017

in Legislation ~ AB 1308, any new bills, Midwifery Politics, Now & Then

Opinion #166 ~ “Informed Refusal” ~ notes:

Almost universally, informed consent laws have been liberalized … from the relatively paternalistic “professional or reasonable physician” standard to the “materiality of patient viewpoint” standard. … In the “patient viewpoint” standard, a physician must disclose … the risks and benefits that a reasonable person in the patient’s position would want to know in order to a make an “informed” decision.

Opinion 214: Patient Autonomy: The Maternal-Fetal Relationship” states that:

  • … medical knowledge has limitations and medical judgment is fallibleExisting methods for detection … are not always reliable indicators of poor outcome, and there is often insufficient evidence for risk-determination or risk-benefit evaluation
  • The role of the obstetrician should be one of an informed educator and counselor, weighing risks and benefits ….and realizing that tests, judgment, and decisions are all fallible.
  • Abiding by the patient’s autonomous decision will provide the best care for the pregnant woman and the fetus in most circumstances.
  • In the event of an emergency … the obstetrician must respect the patient’s autonomy, continue to care for the pregnant woman, and not intervene against the patient’s wishes regardless of the consequences.

ACOG Opinion 214 also identifies serious negative consequences when a patient’s autonomy is violated:

  • A woman is wronged and may be harmed, whether physically, psychologically or spiritually.
  • The patient’s subsequent loss of trust in the healthcare system may reduce the health care provider’s ability to help her and may deter others from seeking care.
  • There may be other social costs associated with this violation of individual liberty.

According to ACOG Opinion 214: “abiding by the patient’s autonomous decision will provide the best care for the pregnant woman and the fetus in most circumstances”.

This policy statement goes on to say that: In the event of an emergency … the obstetrician must respect the patient’s autonomy, continue to care for the pregnant woman, and not intervene against the patient’s wishes, regardless of the consequences.”

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