Patient Autonomy

Click here to read an interesting story of patient autonomy. The mother was a Hmong woman who believed in reincarnation (so if her child died, it would come back as another child), and also that if she were cut open during a C-section that good spirits would leave while evil spirits would enter her body; so C-section was not an option for her, even if her child’s life was in danger… or her own. She had a partial placenta previa, and her doctor was preparing to obtain a court order to force her to have a C-section to keep her baby alive. While she did not make the choices I would have made (insisting on a vaginal birth with such a risky condition), she found another doctor who supported her choices, and even offered to testify on her behalf at the court hearing.

Did Se understand the risks, or as some physicians have suggested, was she unable to really grasp the implications of her choice in order to give an informed consent?  I believe she clearly understood that she or her baby could die; I believe she felt that death would be preferable to the consequences of an incision in her body.

This is in contrast to the Florida woman who was court-ordered into hospital confinement and bed-rest at 25 weeks gestation. While I can understand the desire to save the baby’s life and health, I also think that the mother has the right to choose between two different options, and to seek a second opinion if she desires. Especially since (unless I’m mixing up stories, or getting something wrong), the bed-rest did no good, and the baby died three days later… which to me shows that the mother was certainly within her rights to question the validity of the bed-rest that the doctor was ordering. Actually, I might say that the doctor was merely suggesting it, with the performance of the act being dependent on the mother’s ability and desire to follow the suggestions, based on her understanding of the risks and benefits of bed-rest in her situation. Also, I might add that it is possible that the stress of being confined, against her will, in a hospital, away from her children, may have added a degree of stress to an already stressful situation, and was certainly not helpful and perhaps harmful to the baby.

Two different ways of handling a situation, one respecting a woman’s right to choose the medical care that she feels was best in her situation (though I couldn’t say that it was what was best for her child, since I do not believe in reincarnation — at least in her mind, the child’s death was not harmful to him, for the soul would come back in another body); and the other disregarding her intellect and understanding and right to a second opinion.

2 Responses

  1. I really was thrilled to read about the Hmong woman being supported in her decision. While I certainly don’t have those beliefs and would not have chosen that course, I respect that someone had the balls to fight for her!

    We occasionally have patients who are ‘difficult’ for various reasons, may have been ‘fired’ from a previous practice, etc. We don’t fire women because they don’t comply with what we want. I can think of only one patient we have fired (and it was actually one of the docs patients and he agreed) and it was because she was verbally abusive to staff repeatedly.

    One we won’t be firing – a 46-year-old who wants a VBAC, has an indexed and tabbed birth plan which includes research that supports or refutes pretty much everything under the sun. We understand that she was burned badly when having her first baby. We will try to turn this into a positive experience and get her to come from a positive place as opposed to the current negative place. But we won’t turn her away.

  2. I found this story amazing too! How wonderful she found someone to support her desires.

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