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Archive for November 22nd, 2011

My sense is that informed consent is only as good as the people enacting it.

After my last post (inspired by an obstetrician’s blog post about how inane the IC process feels to him in its current form), I remembered a recent experience during which the informed consent process seemed especially silly. The anesthesiologist was required to get an IC form signed by a woman in early labor who was planning a natural birth. She rolled her eyes as she gave it to him. She was very angry that she had to see an anesthesiologist during her natural hospital birth. It sort of negates the whole plan of “not being offered pain medication unless I ask for it,” eh? Given that informed consent is, in part, about acknowledging the decision-making power of the patient, it felt especially ironic that she had no power to make the decision not to be offered pain medication. (Our hospital requires this in early labor.)

It  made me think about a distinction we make in anthropology between “ideal” and “real” forms. In its ideal form, informed consent is supposed to help all the parties involved. There is a certain expectation that information will be presented neutrally, I think, so that the Decision Maker (in this case, a laboring woman) will be able to make her own (uninfluenced) decision.

But that ideal is impossible to attain because the person asking the patient or laboring woman to sign a form is exactly the person who is advocating a particular course of action/treatment. There’s no neutrality there by definition. So as some doulas and midwives say, it can feel more like “informed coercion” than “informed consent.” When it works like that, it can feel inane to all involved, I think. Why go through the motions if they are nothing more than motions?

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