Informed Consent & Refusal: an Ethical and Pragmatic Guide
Birth is a normal physiological process that usually occurs without intervention. When intervention in childbirth is indicated, a woman’s informed consent is required. Yet threats to informed consent exist: over-estimation of risk, imbalance of authority, and restrictive administrative policies can all coerce women into undesired interventions. When there is a conflict between caregivers’ recommendations and a woman’s informed choice, should autonomy or beneficence prevail?
Dr. Kotaska will address the ethical concepts of autonomy, beneficence, and non-maleficence as they relate to the process of informed consent. He will develop a framework for optimal informed consent that includes:
1. a woman’s right to complete unbiased information regarding all clinical alternatives, including no intervention;
2. her right to access her chosen alternative;
3. her right to decline any recommended treatment without prejudice, and nonetheless to receive excellent care in accordance with her values and choice; and
4. her ethical and legal responsibility for adverse outcome associated with informed refusal.
Dr. Kotaska will discuss the critical value of the therapeutic alliance and challenge caregivers to preserve it, even when women’s choices diverge from guidelines or caregivers’ recommendations. He will provide practical advice on risk estimation and highlight the difference between “offering” and “recommending” intervention. The integral role of clinician objectivity, humility, and self-awareness to achieving truly informed consent will be explored.