Monday, October 19, 2009

RECAP: October Meeting on Informed Consent/Patients Rights

Here is a recap of what we discussed for our October ICAN of DuPage Meeting. The topic of informed consent is of a legal and ethical nature. Some of this information may be overwhelming, but for some it can arm you with the knowledge you need to protect yourself from undo stress. While neither ICAN of DuPage leader is a practicing attorney and cannot offer legal advice, all of the information contained below is freely available to the public. If you need more help, contact an attorney.
  • You have the right to Informed Consent
  • You have the right to refuse any treatment
  • You have the right to amend or change consent forms and only agree to the parts you want
  • Providers who perform procedures against your will are in violation of the law
  • Providers who coerce or threaten mothers with forced cesareans are in violation of their own code of ethics, and can be held legally accountable
  • What you can do if you need to file a complaint against a provider

We passed out this brochure - "The Rights of Childbearing Women" published by Childbirth Connection.

We also discussed some recent stories about mothers being forced or coerced into treatments they did not want or need, and talked about Jen's birth story (which you can find here, if you have not read it already.)

If you choose to refuse only parts of care or treatment, you can find a "Fill in the Blanks" sample consent form here:

We also touched on quite a few other stories in the news, and what our legal recourse is for them. If you need to file a complaint against a provider, you can start here:

All patients, even pregnant mothers, have the absolute right to informed consent and informed refusal. Procedures performed against your will without signed consent are unlawful and constitute criminal battery. In the case of "Meador v. Stahler and Gheridian (, a jury awarded a $1.5 million settlement to a Massachusetts woman and her husband for undergoing a medically unnecessary cesarean that she had made clear she didn’t want." (taken from "Enforcing and Promoting the Rights of Women Seeking Vaginal Birth After Cesarean (VBAC): A Primer": Prown's article will be referenced through the rest of this entry.

According to Prown, The ACOG's own code of ethics is "adamant in protecting [a mother's] right to refuse, declaring that patient autonomy in making medical decisions must be respected at all times; that physicians must obtain informed consent for any medical or surgical treatments; and that a patient’s decision to forego treatment based on cultural or religious beliefs and personal preference or comfort must be honored.

While failing to meet the ethical guidelines required by their profession won’t subject physicians to criminal prosecution, such violations are grounds for losing the right to remain licensed to practice or to become subject to assorted other disciplinary actions. As a whole, the body of state, federal, and case law makes it clear that hospital policies mandating cesarean section violate the legal rights of pregnant women and constitute violations of professional ethical standards as well. In fact, no physician has ever been sued or held liable for neglecting to appeal to the courts to order a cesarean that a patient has refused (see, “Jehovah’s Witnesses, Pregnancy, and Blood Transfusions: A Paradigm for the Autonomy Rights of All Pregnant Women”"


"Many people are under the mistaken impression that in instances where they disagree with their physician about a course of treatment, their doctor has the right to discontinue care. However, professional ethical guidelines stipulate that a physician may only terminate care after reasonable notice and after providing for necessary interim or emergency care. Physicians who fail to meet these guidelines may be charged with patient abandonment, which is grounds for malpractice and constitutes a violation of ethical conduct that could result in loss of licensure. As a general rule, physicians who wish to discontinue care in a non-emergency situation must notify patients in writing, give 30 days’ notice and offer a general referral to other physicians in the area. However, if ongoing care is required at the time the physician wishes to terminate care (certainly the case with pregnancy), then the physician must ensure that the patient is transferred to a specific provider."*


"In recent years physicians in various parts of the country began appealing to the courts when pregnant women refused to undergo treatment on behalf of their fetus. In the majority of cases, the courts sided with physicians and ordered women to undergo cesareans against their will. However, appellate decisions (which hold the force of law) have since upheld the right of pregnant women to refuse treatment, even in situations where their physician believes the life of the fetus to be threatened.

The most widely cited case, In Re. A.C., involved Angela Carder, a pregnant cancer patient who refused to consent to a cesarean at 25 weeks gestation and stated that she wanted to undergo cancer treatment instead, which her doctors believed would kill her fetus. Officials at George Washington University Hospital intervened and obtained a court order to force her to undergo a cesarean that neither she nor her baby survived. Her estate appealed the decision and won.

The Court of Appeals upheld the right of pregnant women to make all medical decisions on behalf of themselves and their fetuses, arguing that to compel invasive treatment on pregnant women would give fetuses rights superior to those of the mother and diminish the rights of born children whose parents could not, by law, be forced to undergo surgery or donate organs on their behalf. The court further ruled that the viability of the fetus and any potential harm the mother might cause to it by refusing treatment could not override her fundamental right to bodily integrity and informed consent/refusal.

It’s important for VBAC mothers to know that the Carder ruling has had a very chilling effect on the willingness of doctors or hospitals to use the courts to force women to undergo cesareans. Many continue to use the prospect of a court order as a threat to coerce women to consent, but hospitals, doctors, and their attorneys are well aware that, should they proceed and should the mother decide to appeal, they’re looking at a long and expensive legal battle that they will lose in the end.

Any VBAC mother who’s threatened with a court-ordered cesarean should inform staff that she knows that it’s an empty threat, that case law is on her side, and that she plans to appeal the ruling all the way to the Supreme Court if need be."*


*Prown, Katherine. "Enforcing and Promoting the Rights of Women Seeking Vaginal Birth After Cesarean (VBAC): A Primer." International Cesarean Awareness Network. .

For a clear outline of your rights as a pregnant woman, please visit:
For a clear outline of your right to informed refusal, please visit:

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