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Informing ourselves about ‘informed consent’

By Lottie V. Spady

This is the second in a series of columns on the 13th Environmental Justice principle: Environmental Justice calls for the strict enforcement of principles of informed consent, and a halt to the testing of experimental reproductive and medical procedures and vaccinations on people of color.

What exactly is “informed consent,” and whose responsibility is it to enforce these principles?

As defined by the American Medical Association, informed consent is a process of communication between a patient and physician that results in the patient’s authorization or agreement to undergo a specific medical intervention. The physician providing or performing the treatment and/or procedure should disclose and discuss with the patient:

-Diagnosis, if known

– The nature, purpose, risks and benefits of a proposed treatment or procedure

– Alternatives (regardless of their cost or the extent to which the treatment options are covered by health insurance)

– The risks and benefits of the alternative treatment or procedure

– The risks and benefits of not receiving or undergoing a treatment or procedure

In turn, the patient should have an opportunity to ask questions to gain a better understanding of the treatment or procedure, so that he or she can make an informed decision to proceed or to refuse a particular course of medical intervention.” This decision is recorded in writing as part of the patient’s records.

This all sounds very clear and straightforward. The ability to give consent implies choice. It seems for the most part, however, the existing principles of informed consent only gives the illusion of choice to the patient and are mainly concerned with protecting the doctor from medical malpractice.

Historically, the principles of informed consent evolved from the belief that the doctor is considered the expert who is delivering the information. In order to make a decision based on that philosophy, a relationship of trust is required between patient and physician. A patient must believe that the physician is advising treatment in the patient’s best interest. One cannot help but wonder about biases in this information, which may arise from trends in courses of treatment or procedures that save the most time or make the most money. There are now commercials for commonly prescribed drugs that are doing some of this “informing” as well and further support the narrow message of western medicine: “either cut it off, cut it out or prescribe a pill.”

The principles of informed consent imply the ability to refuse a treatment or procedure as well, but at what cost? Eighteen years ago, when I was pregnant with my first child, I decided early on that I wanted as natural of a child-birth as possible. I was particularly freaked out by epidural anesthesia, where a needle is used to insert a thin tube or catheter between the bones in the lower spine so that numbing agents can be given during labor. I spoke up and informed my obstetrician that an epidural would not be one of my options for pain relief. I shared my research from other mothers and well-written books on the topic, which stated that despite the extreme discomfort of contractions and delivery (you know, the stuff of childbirth since the beginning of time), the mother’s pain immediately ceases afterward and the child is not drugged in the process. He shook his head and laughed at me in that derisive manner, which let me know he was questioning my fitness as a mother. He even raised his voice when he said exasperatedly, “You do not want to do this without an epidural!” That was my last visit to him. The head of obstetrics took his place for all subsequent visits and my healthy son was delivered without an epidural.

As stated in the above definition, alternatives are to be discussed as well. A recent conversation with an expectant mother, however, refuted that claim. She questioned her obstetrician’s intent to deliver her twins by caesarean section and indicated that vaginal delivery was her preference. Her obstetrician proceeded to go into a lengthy explanation as to why this would not be possible, especially if one of the twins was turned in the opposite direction. The mother’s question at that point was what can be done to turn a child to prepare for a vaginal birth. This was met with another round of reasons not to go this route as if the mother had suggested something unnatural and immoral. When the mom insisted on being given information regarding natural childbirth for her twins, she was summarily discharged from the obstetrician’s patient roster. She has since found a more knowledgeable obstetrician, but therein lies the punitive nature of informed consent.

In order to receive the benefits of informed consent, we have to take an active role in advocating for our bodies as healthy environments. We cannot be afraid to ask the hard questions, demand adequate time for explanations, and explore all of the options that resonate within us. The doctor/patient relationship is a team of which both members are valuable.

Lottie V. Spady is part of the Justice Communications team in Detroit and associate director of East Michigan Environmental Action Council. She can be reached at lottie@emeac.org or www.emeac.org

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