Page 31 - OB Risks - Delivering the Goods (Part One)

SVMIC Obstetrics Risks: Delivering the Goods

fetal heart tracings indicated that the baby was in distress.
The physician made the decision to convert the delivery

to a cesarean section. Once the C-section was begun, a
ruptured uterine wall was identified, and the infant was

found stillborn in the abdominal cavity.

In both cases, the physicians’ defense was significantly impaired
because of the lack of a detailed informed consent discussion.

It is important to note that these were communications issues
rather than documentation issues, as the physicians involved

acknowledged that each did not have an informed consent
discussion with their patient.

Informed Refusal

Informed refusal is the flip side of informed consent, and it
acknowledges that every competent patient has the right

to refuse a recommended test, procedure, or treatment.

Informed refusal mandates, though, that the physician or
healthcare provider inform the patient of the risks and possible
consequences of the refusal. A common form of refusal is

the patient who leaves the hospital against medical advice.

Any physician who finds himself with a patient insisting to be
discharged against medical advice should accurately detail and
document the explanation of foreseeable consequences and

possible impact of refusal of treatment.

In order to successfully defend these cases, there should be
clear and documented evidence that the patient was provided

sufficient information on the risks of going without treatment.
Both informed consent and informed refusal are predicated

upon the notion that a patient is entitled to all information

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