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

patient’s decisions. The patient must consider the risks of losing the baby, the risks
of a damaged infant, and the risks that she is willing to assume to carry the baby.
The decisions of a married woman in her thirties who has taken years to conceive
are likely to be very different from the decisions of a single woman in her teens
who is considering adoption. A patient who does not tell her physician about her
desires and expectations should be asked about them. Most women have a personal
image of childbirth that the physician must understand. The further this image is
from reality, the greater is the likelihood of conflict.
The physician should work to avoid exercising undue influence on the patient’s
decisions. If there are strong medical reasons for making a certain decision, the
physician should make these reasons clear. The physician should realize that the
social reasons may outweigh the medical reasons for a particular patient. The
choices of a married male physician in his forties with six healthy children at home
are not likely to match the decisions of either of our hypothetical patients.
b) Risks to the Baby
Although pregnant women have great latitude in assuming the risk of various
medical care options, they do not have an unlimited right to assume risks for the
baby. Physicians should be careful not to agree to medical care that unnecessarily
increases the risk to the baby. For example, a physician may not want to accept a
patient who refuses consent to a Cesarean section under all circumstances. The
physician should not humor the patient with the intention of forcing care on her
when an emergency arises. Physicians should be wary of situations that limit their
options in an emergency. Conversely, physicians must tell their patients of the risks
that are imposed by their practice styles. Physicians who practice at high altitudes
or in facilities that cannot provide proper emergency services must document that
the patient understands that she and her baby are at substantial additional risk
because of these factors.
5. Emergencies
It is particularly important that the physician and patient discuss what will be done if
an emergency arises or something does not work out as hoped. A woman who wants
a large family may be very upset if a Cesarean section becomes necessary during her
first delivery. If she has not been prepared for the possibility, she may become angry
with the physician who is doing the surgery. If the reason for the Cesarean section
leads to a birth injury, this family is primed to sue. In contrast, if the woman
understands that Cesarean delivery is necessary if the fetus is in trouble and that it
does not necessarily lead to repeat surgery and limited family size, then she is better
prepared for the surgery and the possible adverse outcome in the baby.
The physician should document how the birth plan will be modified for different
emergencies to obviate the emotional turmoil that occurs when the patient’s
expectations are suddenly disappointed. This gives the patient time to consider and
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