Rights and Responsibilities

In my conservative Christian social studies curriculum, we had a section on rights and responsibilities, to teach us that neither rights nor responsibility is unfettered, but joined. For example, the “right” to drive a car is coupled with the responsibility to drive the vehicle safely. I’m not sure if other curricula have that, but it seems like too many people these days are worried solely with rights, without the corresponding responsibilities that go with them.

I was made to think on this topic because of Dr. Lisa Masterson’s statement, in an episode of The Doctors, “We as obstetricians take on that responsibility [of getting a baby out]. You don’t want to take on the responsibility for your child. You absolutely do not.”

In my opinion, it is this attitude that causes doctors to be prime targets for litigation. There are other factors involved in this — perhaps some “entitlement” attitude that everyone deserves a healthy baby and risk-free birth, or a “victim” attitude that if something went wrong, it cannot be “just one of those things” it must be somebody’s fault — but I wonder how much of the increase in litigation is due to the inseparable nature of rights and responsibilities. ACOG is notorious for championing a woman’s “rights” to birth control, abortion, and elective Cesarean. They are also notorious for their statements and positions which have squelched a woman’s “rights” to give birth outside of the hospital, to choose a VBAC, to choose a breech birth, or even to eat or drink as they desire while they are working harder than they have ever worked in their lives, to bring forth life. As I’ve said before, how “elective” can a C-section be, when that is the woman’s only choice? And if women are not given the rights to choose to give birth as they wish and where they wish, why should not the doctor who refused their right to choose take on all the responsibility for anything bad that happens during the birth? They surely want to take all the credit for anything that goes right!

I think this is one of the reasons why midwives are not sued at the same rate as doctors. Midwives tend to treat women more as equals, whereas doctors tend to treat patients as inferior. This is not a blanket statement, but doctors do have years and years of knowledge, which may give them a superiority complex. Dr. Masterson shows this in her arrogant way of speaking — I would loosely “translate” her attitude as, “I’m the doctor; the best thing you can do is to follow orders; I have years of education, and know so much more than you do it’s not even funny; you cannot possibly understand the aspects of your care, so just leave all the hard decisions to me, okay, honey?”

As one of the commenters said on The Unnecesarean’s discussion about “The Doctors”,

I’m ready to VOMIT here. Masterson is completely full of crap, and I cannot believe they used that Janna woman as an example of what can go wrong! If anything, her experience should send the message that modern medicine and ultrasounds are NOT 100% accurate!!! Makes me sick. And I love how they so conveniently “forgot” to admit that DOCTORS were the reason behind most deaths in childbirth, from not washing their hands after performing autopsies.

The attitude of Dr. Masterson is EXACTLY why I’m birthing this child at home on my own!! I was bullied and manipulated into a C-section I did not want or need with my first pregnancy, and have since done extensive research. I know my body was made to birth this child, and it is highly unlikely I will have any problems, since I am refusing all interventions. If I feel or see that something is not right, yes I will transfer to a hospital, but this time I am in charge of my body. 🙂

Now, if a woman feels bullied, manipulated, coerced, or forced into a C-section that was unnecessary, and experienced any negative side effect from it, should she bear all the responsibility of the surgery, since she had no right of refusal? Or does the doctor who had all the “rights” need to bear all the responsibility?

There was a case a few years ago, of a young woman who gave birth to a baby in the footling breech position, choosing a home birth with a midwife, even when it was known that the baby was in the breech position. Sadly, the baby did not survive. When the midwife realized that she was not able to get the baby out (although she had previous breech birth experience), she called the paramedics, who rushed to the house and back to the hospital, where the doctors eventually were able to free the head. The two doctors involved in the case were livid that the breech birth was even attempted (even though the Canadian version of ACOG, the SOCG, has recently said the evidence does not support 100% C-section for breech), and filed a complaint with the midwifery board; I seem to recall that they even wanted charges pressed against the midwife, but I did not see that in the newspaper article (but I might have missed it, since I only scanned the article, already being familiar with this case). While I understand the doctors’ anger and frustration, it is noteworthy that the mother is angry not at the midwife who attended the case, but at the doctors who are attacking her midwife. Perhaps more doctors who wish to avoid a lawsuit should take note of this case. This woman absolutely lost her baby’s life due to birth choices (footling breech is one fetal position that some even pro-breech-birth advocates will say is a contraindication for vaginal birth, particularly in first-time mothers; but it is not absolute — there are numerous successful footling breech births; this was not one of them), but she is not angry at the practitioner, nor is she wanting to file a lawsuit against her, get her license revoked, nor anything else negative against the midwife. She is in fact defending the midwife, and more or less attacking the doctors. The lesson to be learned is that this young woman was given the right to make her own choices, and she is taking on the responsibility of those choices. She basically said, “It was my choice, not the midwife’s; she supported my choice, so back off.” What would have been the outcome if she had been forced into a C-section (in her opinion, without a good reason, since breech babies have been born for millennia; perhaps she might have changed her mind and willingly had a C-section with more information presented; perhaps she had all the information available to her), and her baby died anyway? Or if the baby was injured from a C-section (either something mild such as a cut from the scalpel, or something worse), or if she was one of the few women who suffer severe problems from their C-sections? How likely do you think she would have been to sue? I’m guessing “at the drop of a hat” would be an appropriate cliché to use.

Now, the flip-side is, that if women choose things, if they take on that right, they should bear the responsibility for the outcome. Apparently, it’s not that simple, because some women have chosen things and then turned around and sued the doctor for not preventing them. I think that’s bogus. If this is legally the case, there needs to be changes in law and loopholes closed to give doctors protection. If people have rights, they should bear the responsibility; if only doctors have the right to choose what happens to birthing women, then they should bear the full responsibility. If, however, women take the rights which are truly theirs, and make choices, then they take on the responsibility, and effectively limit their ability to sue.

I remember when I was first meeting with the midwife I selected when I was pregnant the first time. She told me a lot of things, including statistics and things, but also said that she “practiced bare” — she had no malpractice insurance. I had never really thought about suing her or any other care provider, but her saying that, naturally turned my mind to a lawsuit. I said something like, “So, if we sued you, we’d basically end up with nothing anyway, huh?” Saying that and thinking that made me think more seriously about the choice of care provider. I recognized that there was no guarantee, and that if I “bought a ticket” and hired this midwife, I would have to “take the train” wherever that led, unless I opted later on to go with a different care provider. That making this choice of care provider was tacitly choosing everything else that might follow, even if I didn’t know what else might follow. But that is the choice that everyone makes — whether they realize it or not — when they choose their care provider. If they choose an obstetrician like Dr. Masterson, then they shouldn’t be surprised that the train takes them into a place where the doctor calls all the shots and gets upset when the woman wants to choose anything. This should make women very cautious about their choice of care provider. “An ounce of prevention is worth a pound of cure.”

Sometimes I hear stories that just make me shake my head, and say, “What did you expect?!?!” That’s my internal response; I’m much more polite in my vocal response. 🙂 But it is frustrating for me to sit back and watch people hand over all their rights to the doctor (or anyone else, for that matter), and then get upset at the outcome. Kinda like people who gripe and complain about politicians, but don’t vote, y’know? Or they vote in the same crop of politicians over and over, expecting a different outcome the next time. What gives?! In one way I sympathize with people — certainly so, if they were misled — but another part of me says, “Well, you picked a doctor with the 70% C-section rate — why did you think you would not end up with a C-section?” It’s a fine line to walk — if you say something, it’s rude and “victim-blaming”, so usually I end up not saying anything. [Like my mom always said, “If you can’t say something nice, don’t say anything at all.”] At some point, though, just saying nothing, or saying something polite might be enabling people somehow. And I don’t want that. A tough line. Hard to know what to say and when, or even if.

We as obstetricians take on that responsibility [of getting a baby out]. You don’t want to take on the responsibility for your child. You absolutely do not

2 Responses

  1. Interesting post – I enjoyed it. Unfortunately informed consent does not protect one from a lawsuit. Just because I inform a woman of the risks and benefits of VBAC vs repeat c/s will not sue if something catastrophic occurs. Because we are a society, as you mention, that must blame someone. Never does that responsibility lie with self. This post speaks well to that. It makes being a healthcare provider (even a good one) a highly stressful job with quick burnout. I love my job. But I can see where the burnout comes into play. You have to worry that you are providing perfect care.

  2. Amen! Great thoughts.

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