Sunday, November 16, 2008

Medical consent

Headlines this week about the case of a 13 year old, whose decision to refuse a heart transplant was subject to legal challenge by doctors, made me ponder how much has changed, just during my adult lifetime, in the area of consent to medical procedures

My husband was suddenly called overseas shortly before our first child was due. In the flurry of arrangements nobody thought to get him to sign the consent forms for any treatment I (or the baby) might need during the confinement

I could not sign because I was under 21 – the age of majority then

When I was actually admitted to hospital in labour the necessary consents were obtained from my father, by phone. Fortunately no special or extraordinary medical procedures were necessary

After the birth however I was considered perfectly competent to sign consents for my daughter to have blood tests etc

Actually I am not sure that it was just my age which caused the problem. Whether it was the law, or just custom & practice, ‘everybody knew’ that a husband’s consent was needed for anything which might affect the life of his wife or child, or her fertility, or his conjugal rights

This actually changed some time during the 1970s, but again I am not clear whether it was the law or just common consent

During the 1970s my professional practice was affected by something which everybody used to call ‘the ethical problem.’ Nobody – not the doctor, the parents or the child concerned – was competent to give consent to, for example, the taking of a blood sample purely in the interests of research. The Medical Defence Union’s standard advice was that the doctor could be liable to a charge of assault if anything went wrong, no matter how fully informed the parties to the decision had been.

This meant that, for example, one could not take control samples in any study of the effects of environmental pollutants on children’s health, there had to be a known source of potential exposure for each child. Friends still working in this area tell me that things have changed now

Listening to some of the radio interviews with doctors, lawyers or ethicists about the case of the girl & the heart transplant helped me to understand a little better why on earth anyone would take it upon themselves to take her to court (though to be fair, we never heard from them, & it is not totally clear that the issue was the transplant itself or some other part of her treatment). Even so, there was a tinge of ‘Oh what an interesting case’ in their voices

Since the need for a transplant in this case is iatrogenic, I think a decent reticence was needed



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