When it comes to medical care, there are so many papers to fill out and forms to sign. It’s no wonder, then, that many pregnant women hear the term “informed consent” and focus first on the consent part. You select your medical support team and providers, then you give them consent to treat you — but there’s an important component of that equation that you don’t want to miss: make sure your consent is in fact, informed.
As defined by the American College of Obstetricians and Gynecologists (ACOG), informed consent is a six-part process, with two steps for the patient and four steps for the physician. To steer your pregnancy towards the best outcomes for you and your baby, it is important to be aware of these steps and several other key factors when you are exploring care options.
5 Questions to Help You Unpack Informed Consent in Pregnancy
What is informed consent? Informed consent means understanding the purpose, benefits, and potential risks of your chosen medical treatment.
What are the two key components of informed consent for patients? According to the ACOG, they are:
- Understanding treatment options (comprehension)
- Arriving at a mutually agreeable treatment plan (voluntariness)
Discuss available treatment options and arrive at a treatment plan both you and your physician agree on.
What are the four key components of informed consent for physicians? The ACOG specifies the cornerstones of informed consent for physicians, too. They are:
- Physician’s obligation to help patient (beneficence)
- Balancing competing interests (justice)
- Physician’s obligation to do no harm (non-maleficence)
- Support patient’s self-determination (autonomy)
Does informed consent involve patient choice? As the patient, you have the final say in your choice of treatment plan. That is a key element of informed consent. This means it is the physician’s ethical obligation to support you in your choice, even if the physician believes a different treatment plan may be preferable.
Are there pressures against patient choice in our current health care system? Hospitals and payers — including insurance companies, Health Maintenance Organizations (HMOs), managed care, Medicare, and Medicaid — have greatly eroded patient choice and indeed physician choice by usurping the ability to have the final say as to whether the treatment will be covered or not, and by controlling which physicians you may see.
The first informed consent a pregnant woman will make is choosing what doctor to see during her pregnancy. Insurance companies should not have the ability to narrow the list of physicians, but unfortunately many women face this reality. It’s quite possible you prefer going to a doctor outside your insurance company’s chosen group.
The ethics of autonomy and free choice should not be ignored or eroded for the purpose of large corporations making a profit. It’s a big job, but consumers need to begin taking back their ethical rights. Take a few minutes after reading this article and contact your legislators to share your concerns. If only 3 or 30 patients do, nothing will improve. If 3 million or 30 million patients do, change will occur.
About Dr. Alan: An obstetrician and maternal mortality expert, “Rural Doc” Alan Lindemann, M.D. teaches women and their families how to create the outcomes they want for their own personal health and pregnancy. In his nearly 40 years of practice, he has delivered around 6,000 babies and achieved a maternal mortality rate of zero! Learn more at LindemannMD.com.