Tuesday, May 11, 2010

Staying Objective When Talking About Informed Consent

As childbirth educators, doulas, lactation consultants and nurses/physicians, we all use informed consent when presenting information to our clients/patients.  To thoroughly understand the need for objectivity in presentation, one must first understand the meaning of informed consent.

What is informed consent? Informed consent, or freedom-to-choose, have become frequently used terms, not only in the current maternity/health care environment, but also in every day life. The idea of informed consent fosters learning about the birthing event that may change a woman's perception about her role as a mother and quite possibly her total self-concept. To interfere with this growing and learning process, to stifle the process of informed consent is possibly to set up a situation of sadness, anger, disillusion or feelings of failure.Informed consent is a legal doctrine in America that is defined in all 50 states as consent to treatment (for example, consent to a cesarean section/ abdominal surgery to assist in the delivery of the baby) obtained after adequate disclosure. As defined by Ethics in Medicine from the University of Washington School of Medicine, informed consent "is the process by which a fully informed patient can participate in choices about her health care. It originates from the legal and ethical right the patient has to direct what happens to her body and from the ethical duty of the physician to involve the patient in her health care."

This definition is simple in theory but complex in operation. The problem is, "What is adequate disclosure?" Adequate disclosure varies from state to state. Informed consent is defined in most states as a consent obtained after telling the patient the following:

1. What is the proposed treatment or procedure? Make sure you fully understand what is suggested and how it is done.

2. What are the benefits?

3. What are the risks?

4. What are my alternatives?

5. What would happen if I did nothing?

That being said, informed consent should go one step farther and incorporate voice inflection, facial expressions and body language when covering the above 5 steps as to not to overtly or covertly influence behaviors.  This involves knowing ones triggers and being in control when discussing trigger-producing subjects.  For example, if a care provider has deep feelings about epidural anesthesia, their voice or body language may "say" one thing while the words that they say may "say" quite another.

To be absolutely fair and present informed consent in an unbiased way, our body language should be appropriate.  Acknowledge that body language can be a powerfully persuasive tool and assess yourself for body language cues.  With an estimated 55%+ of what you say as nonverbal, what are you saying to clients/patients?  Our voice intonation tells a whopping 38% and only 7% is verbally what we really mean.  So in a normal conversation, 93% of what someone else is getting from us is NOT coming from the actual words we are using!

Yes, it is very difficult to be objective when discussing a concept that is a trigger or perhaps giving unbiased information.  But if we truly espouse the concept of freedom of choice based on knowledge of alternatives and informed consent, then it is our duty to make every possible effort to present information in an unbiased and objective manner.  It is up to our clients/patients to make decisions ~ not us.

No comments: