Public Health Law Map - Beta 5 - Medical and Public Health Law Site

misinformation. A pregnant woman is the only person who may consent to her
medical care. This is always true for adults, and in most states a pregnant minor has
the right to consent to her medical care. Neither husbands, lovers, prospective
grandparents, prospective adoptive parents, nor adoption agencies have a right to
consent to, or interfere in, the medical care of the pregnant woman. Any discussion
of the woman’s medical care with such third parties is a violation of the patient’s
rights unless she has given her explicit permission.
a) Participation of Others
Although the pregnant woman has the right to exclude all third parties from
consultation about her medical care, most women want to involve other persons in
their decisions. The birth plan should include the names of any persons the patient
designates to receive information about her pregnancy. The patient may also want
to sign a durable power of attorney to delegate the right to consent to care to a third
party if she becomes medically incompetent to consent to her own care. If the
patient wants her husband or other person in the delivery room, this should be
stated in the birth plan. The plan should discuss any restrictions on the presence of
this third person (special training, a hospital orientation tour, etc.) and under what
circumstances the person will be excluded. It is recommended that the husband or
other person mentioned in the plan also be requested to read and sign the relevant
portions of the plan.
4. Risk-Benefit Analysis
Although it is the patient who must consent to medical intervention, it is the
physician who must provide the information necessary to make the decisions. Risk-
benefit analysis in obstetrics is complicated because there are two patients and many
social factors involved. The starting point for risk analysis in pregnancy is the risks
of pregnancy itself. A woman must be warned that women die in childbirth, that 6%
of children have some congenital abnormality, that things may happen in her
pregnancy that will adversely affect the baby, and that some babies are inadvertently
born injured. The woman must be warned about geographic risks such as high
altitude and the limitation of local birth and emergency facilities.
The purpose of this background information is to establish the baseline risks of
pregnancy. Understanding these risks is necessary to understanding the risks and
benefits of various medical interventions. This is especially important for women
who have been exposed to misinformation about the birth process. Some women
believe that modern medicine is a conspiracy to subjugate women. Although
obstetric care could be made much more responsive to the needs of pregnant women,
dispensing with medical attendance is not a proper response to this problem.
a) The Patient’s Interests
The physician should learn as much as possible about social factors that affect a
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