It seems like I have been seeing an increasing number of posts talking about not being allowed to do things as a patient in a hospital, or the idea that hospital staff may place certain restrictions on you. I wanted to take some time this week to talk about informed consent, it's definition, and what it means.
Writing as a doula, a lot of my experience comes from working with laboring mamas, but informed consent is something that applies to everyone. Anyone who is having any medical or alternative treatment done should know about informed consent.
When you are given a form to sign, make sure you read it to know what you are signing. When people come see me for a massage, they are signing a consent form allowing me to use techniques on them that are appropriate to my scope of practice as a massage therapist. The same is true when you see a doctor, acupuncturist, herbalist, etc. By giving your consent, you are allowing us to make judgments about what may be beneficial to your treatment and using those tools. If at anytime, you were made to feel uncomfortable about what was happening, it would be entirely within your rights to revoke consent.
So, what is informed consent?
Informed Consent: Permission granted in the knowledge of the possible consequences, typically that which is given by a patient to a doctor for treatment with full knowledge of the possible risks and benefits.
What does that mean?
Basically what that means is that the practitioner must talk to you about each procedure before hand, list the risks and benefits, and you have to agree to it. If you don't agree, then legally, they can't do it.
You don't have to do anything you don't want to. If you don't want to put on a hospital gown, they can't make you. If they tell you you should be on a certain medication and you don't want it, they can list the risks and benefits, but ultimately, the decision is up to you.
If there is a procedure that your doctor/midwife feels is medically necessary, they will recommend it, but you can decline. By declining to give permission, you are taking full responsibility of any negative event that may occur as a result.
Going Against Medical Advice (AMA)
When you decline a procedure that the primary care provider deems medically necessary, it is called going Against Medical Advice (AMA). A lot of people hesitate to go AMA because they are afraid of being treated poorly by the staff. Some hospital staff will even threaten the patient to get them to comply.
My personal recommendation is that you weigh your options and pick your battles. If something is really important to you, or you are strongly opposed to something, stick to your guns. If there is a good chance of something really awful happening, weigh the risks and benefits of doing it vs. not, and decide what is best for you.
An extreme example would be a mom coming in with preeclampsia and being told she needs to deliver the baby by surgery immediately or risk death. This is a serious medical condition, and could result in death of mom and/or baby. It is fully within this mother's rights to decline the surgery, but by going against medical advice, she is taking full responsibility if she or the baby doesn't make it.
A less extreme example would be a mom going in to triage with regular contractions to find that she is dilated to 3 cm. The hospital policy states that anyone dilated past 2, must remain in the hospital. Mom feels like she would prefer to go home and labor on her own for a little while longer. She is healthy and the baby looks good. It is fully within that mothers rights to leave the hospital AMA, and return at a later time. The risks of her leaving at that point are minimal.
It is not unusual for some hospitals to tell you that if you leave AMA and come back, insurance will not pay. This is a MYTH. If they present you with this argument, my advice would be to call your insurance company and ask just to make sure. The staff can't use that argument if you have spoken to your insurance company about it.
Making the Right Decision for You
If you ever start to feel pressured or intimidated, you are also free to ask for a patient advocate. If you ask for a patient advocate, the hospital can't do anything until they provide you with one. A patient advocate is someone who will listen to your concerns, and work with you and the medical staff to protect your rights. They are familiar with medical procedures and policies, as well as laws stating patient rights.
It is also good to remember that you don't have to make decisions right away. If a doctor suggests a procedure and it isn't a true emergency, always ask for a few minutes to think it over. Take that time to do your own research, and talk it over with family. You can also ask for a second opinion. Don't worry about offending your care provider. This is your health and wellbeing, and you should feel confident in your decisions.
Whenever you have a medical intervention to think about, just remember to use your BRAIN. This is an Acronym for questions to ask yourself about the intervention. These questions are:
What are the BENEFITS?- What good things can come out of the intervention?
What are the RISKS?- Can anything negative result from the intervention?
What are the ALTERNATIVES?- Are there any other treatment options?
What does your INTUITION say?- Go with your gut.
What if you do NOTHING?- What if you choose to just keep doing what you have been doing?
Below is a graphic that you can feel free to print out and keep in your wallet to help you make decisions.
The bottom line is that there should NEVER be a point when you feel like you aren't in control of what is happening to you. You should NEVER leave a hospital and feel like you weren't allowed to do what you felt you needed to do. Even if you wind up with an outcome that you weren't expecting or that you aren't happy with, you should always feel like you had a say in your treatment.
Meet the Author
Amanda Tarver, (LMT, CEIM, PES, RMT) is a massage therapist and birth worker in the Chicago area. She is dedicated to using a combination of bodywork and education to help people live a better quality of life.