Hospital sought court order to force C Section

krankykitty

Not sure if this would be better suited to the Pregnancy forum, but I think it may be a bigger issue/debate about the status of women in healthcare systems.

Indo Story on C Section Court Order

The hospital sought a court order to perform a c section on a woman who had previously not given her consent to the procedure. Whether we would agree or not with the rights and wrongs of not taking the medical advice given to undergo the surgery, the fact remains that the woman did not consent. In no other field of medicine to my knowledge can this happen apart from obstetrics/maternity care, in other words, there's no medical procedure a man can be forced into against his will without giving informed consent.

From anecdotes and stories I've heard the maternity services are rife with women who feel that things are being done to them without proper informed consent being sought. I don't know if this is to do with overstretched services but it seems like a general respect for the patient is being lost in some cases, i.e. being treated like a number/piece of meat rather than a person.

What do ye think?

Victor

The objective of the doctors was to prevent harm to mother and child. There was a severe risk of harm to the mother (and child).

From reading some articles, it sounded like she was in denial and I suspect skittish about the matter. Whether there were other issues, I'm not sure.

krankykitty wrote: »

Whether we would agree or not with the rights and wrongs of not taking the medical advice given to undergo the surgery, the fact remains that the woman did not consent.

Ultimately, she did give her consent. No court order was made.

krankykitty wrote: »

in other words, there's no medical procedure a man can be forced into against his will without giving informed consent.

Actually, in the mental health and public health arenas, e.g. Tuberculosis, people can be detained and treated indefinitely, if necessary.

krankykitty

Victor wrote: »

Ultimately, she did give her consent.

She did, but it took bringing the case to court...

It's probably a hard case to comment on specifically, because there are a lack of details, but in general, is there a situation with some hospitals/doctors/midwives where people aren't given the proper opportunity for informed consent. Is it because there's another life (unborn baby) at stake that this is the case, or is it something that's a hangover from a past age where the likes of Dr Neary did whatever they wanted?

I'm not necessarily talking something as extreme as a section, but other procedures such as internal exams in labour or cervical sweeps done without permission.

krankykitty

Victor wrote: »

Actually, in the mental health and public health arenas, e.g. Tuberculosis, people can be detained and treated indefinitely, if necessary.

Didn't know that about tuberculosis. Forgot about the mental health acts...

xLexie

I would agree in that, consent or no consent, they were right to carry out the c section if it prevented either/both mother and baby dying.

I also support giving the blood transfusions when the patient has refused it for themselves/a child.

I would assume the doctors are there to ensure safety and save lives, could you imagine the chaos (and lawsuits) had they not done the c section and both mother and baby died? What a waste of two lives when it would have been so easily avoidable.

I say this as a woman, but I do think women go out of their way to be offended about something. Had that woman died from not having the c section, there WOULD have been uproar and rightly so. The fact that medical procedures like that aren't performed on men would be because men don't give birth to a new life.

krankykitty

But where is the line between personal bodily autonomy and women becoming seen by caregivers as "childbirth vessels" who should just go along with whatever they are told? Because they are giving birth to a new life, they should suck up whatever a medical professional wants to do to them?

Maybe it is a different situation in a life/death scenario. That's what's the dilemma I guess. Interesting thought on the blood transfusions - I would support a child being given one to save their life against parent wishes but I wouldn't support an adult who has not consented to the procedure (understanding full information that they will die if they don't get it). If someone wants to die for their beliefs well off they go. I would think the legal dept of the hospital would have plenty of documentation regarding this particular woman's lack of consent to the section, so I'm not sure a lawsuit would have held water in the event of her dying as a result of it not happening. Obviously this is just speculation on my part.

How Strange

krankykitty wrote: »

From anecdotes and stories I've heard the maternity services are rife with women who feel that things are being done to them without proper informed consent being sought. I don't know if this is to do with overstretched services but it seems like a general respect for the patient is being lost in some cases, i.e. being treated like a number/piece of meat rather than a person.?

Yes, lots of women have procedures, major and minor, performed on them by health care professionals who believe they know best. Perhaps they do, I can't say but I can't think of many other circumstances where a patient in the healthcare system is expected to comply without question. A lot of the time labour and birthing is managed, Holles street set the international standard for managed labour, so women are on a schedule from the moment they step in to hospital and interventions are routinely used to facilitate the hospitals schedule.

It's hard to know with this case as the information provided was quite vague however I really hope that there was an actual risk to mother and baby and this wasn't a form of coercion on the part of the hospital staff.

I want to believe that there was a real risk in this case otherwise it's a very scary precedent to set. As I said, it was such an extreme course of action that I want to believe there was a real and genuine reason ie risk to mother and baby. We had the Sunita situation when I was at a similar stage of pregnancy and that scared the hell out of me do I really don't want to think that maternity care is going down the route of the threat of court orders for not agreeing with the powers that be.

xLexie

krankykitty wrote: »

But where is the line between personal bodily autonomy and women becoming seen by caregivers as "childbirth vessels" who should just go along with whatever they are told? Because they are giving birth to a new life, they should suck up whatever a medical professional wants to do to them?

Maybe it is a different situation in a life/death scenario. That's what's the dilemma I guess. Interesting thought on the blood transfusions - I would support a child being given one to save their life against parent wishes but I wouldn't support an adult who has not consented to the procedure (understanding full information that they will die if they don't get it). If someone wants to die for their beliefs well off they go. I would think the legal dept of the hospital would have plenty of documentation regarding this particular woman's lack of consent to the section, so I'm not sure a lawsuit would have held water in the event of her dying as a result of it not happening. Obviously this is just speculation on my part.

I think when a woman decides to go through with a pregnancy and have the child, she is by default, acknowledging/accepting that her body isn't just her body for the duration of the pregnancy. The drs and midwives have an obligation to get that child out into the world as safely as it can, and if that means carrying out a c section even against the mothers wishes, if it isn't safe the natural way, so be it.

Again, an adult deciding to give birth to a child and bring a new life into this world should not have to grow up without one of the most important people in his/her life (the mother) when her death would have been so easily preventable, so yes, I would support the HSE seeking a court order to give mother/baby a transfusion if one was being refused.

eviltwin

Its hard to say for sure, we only know the bare minimum of the story and I would like to hear her side of the story before making up my mind. Based on the story it seems madness she didn't agree from the start but I think the hospital were wrong to try to force her. I don't think anyone - even a pregnant woman - should be forced to take treatment she doesn't consent to.

seamus

On principle I see no issue with the individual's personal choice being overridden where that choice presents a real threat to the life or health of the child, or even to themselves in certain circumstances.

Though I do understand, especially in certain hospitals, that the mother's right to choose is relegated below the hospital's resource schedule, which obviously is wrong.

In this specific case, I don't believe that a consultant will go take the extraordinary measure to get a high court order, without good reason. However there is always room for error, as with Michael Neary, so I would like to know that when such an order is sought, there is a party present (who is independent from the hospital) who presents the woman's case to the court.
A consultant making an application to the court is obviously in favour of forcing the procedure, so will be subject to confirmation bias. So it's essential that someone else can impartially present the woman's point of view to the court.

eviltwin

xLexie wrote: »

Again, an adult deciding to give birth to a child and bring a new life into this world should not have to grow up without one of the most important people in his/her life (the mother) when her death would have been so easily preventable, so yes, I would support the HSE seeking a court order to give mother/baby a transfusion if one was being refused.

Do you think parents should be forced to undergo any kind of treatment designed to prolong their life against their wishes in general ?

krudler

Common sense should prevail in an instance where someone is overdue and both her and the baby are at risk, we live in the 21st century no woman should die in childbirth, but they still do, so those doctors did what they needed to, these things don't work out how people plan, if she wanted a natural birth and then it wasn't going to work that way without severe risk to both her and baby then what choice did the doctors have? run the risk of a hugely difficult birth that could lose two people their lives?

if that woman had died or they lost the baby as a result of not doing the section there'd be national uproar as well, no win situation really.

How Strange

I think Dr Neary and OLOL are a part of our awful legacy of prenatal, maternal care. However many women, including my mother in law who is no shrinking violet, sings his praises to this day. But he carried out atrocities on women in the name of what he considered best. No one questioned or stood up to him.

xLexie

eviltwin wrote: »

Do you think parents should be forced to undergo any kind of treatment designed to prolong their life against their wishes in general ?

Yes I think if you're going to bring a child into this world and are stupid and selfish enough to refuse a simple procedure that would save your life, and have the child grow up without his mother because she REFUSED a transfusion, then yeah I think they're right to be forced to undergo it. Yes, she's an adult and it's her choice and all that, but if she's going to be that selfish that she doesn't want to be around to watch her child grow up, maybe your right. The child would be obviously better off for it.

eviltwin

xLexie wrote: »

Yes I think if you're going to bring a child into this world and are stupid and selfish enough to refuse a simple procedure that would save your life, and have the child grow up without his mother because she REFUSED a transfusion, then yeah I think they're right to be forced to undergo it. Yes, she's an adult and it's her choice and all that, but if she's going to be that selfish that she doesn't want to be around to watch her child grow up, maybe your right. The child would be obviously better off for it.

That's very harsh. I'm a parent and while I would like to think in a situation where my health was at risk I would do anything I could to live the reality is I probably would have to draw a line somewhere. I don't think its selfish for anyone to reach a point where they say "enough" and then give up the fight. No one should be forced to undergo any medical treatment just because they happen to have kids.

Honey-ec

krankykitty wrote: »

In no other field of medicine to my knowledge can this happen apart from obstetrics/maternity care, in other words, there's no medical procedure a man can be forced into against his will without giving informed consent.

Jehovah's Witnesses of both genders can be and have been forced to have medical procedures against their will/without their consent.

clairefontaine

krudler wrote: »

Common sense should prevail in an instance where someone is overdue and both her and the baby are at risk, we live in the 21st century no woman should die in childbirth, but they still do, so those doctors did what they needed to, these things don't work out how people plan, if she wanted a natural birth and then it wasn't going to work that way without severe risk to both her and baby then what choice did the doctors have? run the risk of a hugely difficult birth that could lose two people their lives?

if that woman had died or they lost the baby as a result of not doing the section there'd be national uproar as well, no win situation really.

The issue was the unborns right to life vs the right of the mother to refuse treatment.

She thought they had over estimated her due date. This does happen, it's not an exact science. We all know the Irish State owns womens bodies. Always has, even aside from its abortion stance, look at its historical incarceration rates - I dont mean prison, I mean insane asylums and laundries.

There are still borns all the time, it doesn't make the headlines. If Savita Halappanavar hadn't been foreign with foreign eyes peeled this way no one would have cared.

krankykitty

krankykitty wrote: »

In no other field of medicine to my knowledge can this happen apart from obstetrics/maternity care, in other words, there's no medical procedure a man can be forced into against his will without giving informed consent.

From anecdotes and stories I've heard the maternity services are rife with women who feel that things are being done to them without proper informed consent being sought. I don't know if this is to do with overstretched services but it seems like a general respect for the patient is being lost in some cases, i.e. being treated like a number/piece of meat rather than a person.

What do ye think?

There's nothing comparable for men, because the whole pregnancy thing has no parallels. I've no doubt that a man who's (in)actions put a viable child at risk would be compelled by the courts or the threat of action to act on the situation.

I think patient respect is an issue in all aspects of medical care, and sometimes when a patient is in pain and the doctors are coping with an escalating situation, as well as another 20 patients needing attention, the time isn't always there to double check the patient understands everything consent implies, and give fulsome explanations.

All in all I think they did the right thing forcing the issue, its not just about the mother. And all in all I don't think doctors in a hugely overstretched hospital service get the kudos they deserve.

How Strange

Candie wrote: »

I think patient respect is an issue in all aspects of medical care, and sometimes when a patient is in pain and the doctors are coping with an escalating situation, as well as another 20 patients needing attention, the time isn't always there to double check the patient understands everything consent implies, and give fulsome explanations.

All in all I think they did the right thing forcing the issue, its not just about the mother. And all in all I don't think doctors in a hugely overstretched hospital service get the kudos they deserve.

This is where I fundamentally disagree. A woman, as an individual not just a baby carrier, has the right to expect to be treated with dignity and respect.

If the system is overloaded then the system needs to be fixed but to say that a patient should basically shut up and put up is unacceptable in a first world country.

I personally think women who've given birth deserve major kudos for putting up with a substandard system in which they're expected to just comply with the orders of healthcare professionals without question just to facilitate a hospitals schedule.

A woman absolutely has a right to be informed and to give consent in situations where she is of sounds body and mind in that moment. Of course there will always be emergencies but they are just that and the medical staff will have to act in the moment for the safety of the patient. However that is a different scenario.

Dialogue, consent, dignity and respect should always be at the ce tre of all medical care.

rainbow kirby

Firstly - I'm very much not comfortable with the fact that the deeply flawed Article 40.3.3 could possibly be applied as grounds for forcing the procedure in this case.

Secondly - there seems to be a breakdown in the understanding of "informed consent" - rather than heading straight to court, would it not have been a better option to get an alternative medical opinion? Particularly where the dates are concerned - with a 3 week difference between the Feb 24 and Mar 18 posssibilities, further scans could provide a lot of information here. The Irish healthcare system seem to have mastered the art of "put up or shut up", and are willing to be very heavy-handed to get what they want, particularly in cases where women's health is an issue.

clairefontaine

rainbow kirby wrote: »

Firstly - I'm very much not comfortable with the fact that the deeply flawed Article 40.3.3 could possibly be applied as grounds for forcing the procedure in this case.

Secondly - there seems to be a breakdown in the understanding of "informed consent" - rather than heading straight to court, would it not have been a better option to get an alternative medical opinion? Particularly where the dates are concerned - with a 3 week difference between the Feb 24 and Mar 18 posssibilities, further scans could provide a lot of information here. The Irish healthcare system seem to have mastered the art of "put up or shut up", and are willing to be very heavy-handed to get what they want, particularly in cases where women's health is an issue.

The problem is that they would rather have the baby out a little early than take the risks with one born very late, like choking on meconium, umbilical chord complications etc. Also VBACs are very complicated. I can see where the hospital is coming from.

The problem is forcing it on the mother.

I do know of a case where a woman refused a c section and her child ended up with cerebral palsy as a consequence, though in that case the doctors did not warn her or at least in her memory they did not warn her.

In hospitals, if it's not written down it didn't happen, nurses and doctors know this, so it can be very difficult to obtain an honest and whole testimony of what really happened.

One detail in the INDO was that the baby was high and not engaged, and that would tell you there is really no sign of an oncoming labour. But is that because the dates are wrong and teh baby actually isnt due yet or because the body failed somehow?

Morag

Victor wrote: »

Ultimately, she did give her consent.

After the courts were used to bully her and if it found against her she could have been landed with the cost for both sides.

xLexie

eviltwin wrote: »

That's very harsh. I'm a parent and while I would like to think in a situation where my health was at risk I would do anything I could to live the reality is I probably would have to draw a line somewhere. I don't think its selfish for anyone to reach a point where they say "enough" and then give up the fight. No one should be forced to undergo any medical treatment just because they happen to have kids.

I understand there's lines and in serious illnesses with little to no chance of full recovery, I would understand a parent might not want to go through treatment. However, patients recieving a blood transfusion go on to live perfectly healthy and normal lives with little to no impact on their future health.

I can't imagine a parent being in the right frame of mind choosing to die unnessessarily over choosing to accept treatment and be around to see the child growing up.

eviltwin

xLexie wrote: »

I understand there's lines and in serious illnesses with little to no chance of full recovery, I would understand a parent might not want to go through treatment. However, patients recieving a blood transfusion go on to live perfectly healthy and normal lives with little to no impact on their future health.

I can't imagine a parent being in the right frame of mind choosing to die unnessessarily over choosing to accept treatment and be around to see the child growing up.

Neither can I but I don't think its right to force people to undergo medical treatment against their will.

How Strange

My son was born with the cord around his neck. The midwives told me that it happens quite a lot.

On second or subsequent babies it's not unusual for them to engage during labour. Also being high and I engaged may have been because she was 3 weeks earlier than the scan dated her at.

VBACs aren't necessarily complicated, lots of women go on to have them. Some hospitals have a policy of supporting them, such as Holles St, and others don't. But that doesn't make them complicated. Clearly if the baby is in the breech position then the medical team are more likely going to recommend a scheduled section.

clairefontaine

xLexie wrote: »

I understand there's lines and in serious illnesses with little to no chance of full recovery, I would understand a parent might not want to go through treatment. However, patients recieving a blood transfusion go on to live perfectly healthy and normal lives with little to no impact on their future health.

I can't imagine a parent being in the right frame of mind choosing to die unnessessarily over choosing to accept treatment and be around to see the child growing up.

The problem too is OBs pushing C sections have lost credibility.

meeeeh

The child is full term so the "It's my body" argument doesn't really work. Secondly no matter how bad the reputation of medical professionals is they still know more than somebody who read couple of pregnancy books. It was mentioned she already had cesarean procedure so there is a lot bigger chance that the second one would be needed.

I find this example much closer to Jehowah nutjobs refusing blood transfusion for their children than to the unnecessary and harmful procedures without consent.

clairefontaine

meeeeh wrote: »

The child is full term so the "It's my body" argument doesn't really work. Secondly no matter how bad the reputation of medical professionals is they still know more than somebody who read couple of pregnancy books. It was mentioned she already had cesarean procedure so there is a lot bigger chance that the second one would be needed.

I find this example much closer to Jehowah nutjobs refusing blood transfusion for their children than to the unnecessary and harmful procedures without consent.

Yes except in that case teh JWs can't practise their religion, but in Irish obstetrics we all have to practice the religion of the state.

wolfpawnat

A hospital is responsible for the health of all it's patients. On occasion mothers have put their belief's and ideologies ahead of the health of their child. I would condemn any physician that would allow harm to a child. Doctors are only human and are capable of mistakes, and there are many times I would seek a second opinion BUT obstetric care in Ireland is outstanding overall and it is important to think of everyone involved. The child's health, as well as the mothers is paramount. If the mother will not think of it, the doctors have to.

meeeeh

clairefontaine wrote: »

Yes except in that case teh JWs can't practise their religion, but in Irish obstetrics we all have to practice the religion of the state.

BS. Would you be telling somebody at the NCT test that your brakes are perfectly ok regardless what the are saying. Medical professionals believed strongly enough that she was endangering hers and her child's life to go to court. In their opinion she was endangering another life, if she didn't trust the hospital then maybe she should go to another one but as far as I know there were no medical qualifications of mother listed. Besides court could still decide against hospital if their arguments were so iffy.

clairefontaine

That's not what I was replying to meeeh.

Jehovas witnesses can't practise their religion when medics over ride it. But medics in Ireland have to practise the state religion. And we both know what that is.

The spokesperson for the hospital said the issue was around the life of the baby vs the consent of the mother, thus forcing the state religion on the mother.

So one religion supercedes another. A good lawyer would pick that up as a discrimination case.