Informed Consent

Yes, this might seem a bit out of place here. But it’s important. And it has nothing to do with the choices you make personally about how you birth and raise your children – this applies to everyone.

You do not have to obey authority. You don’t. Ever. I had this conversation with my 7 year old recently, actually. Kind of a dangerous conversation to have with him, but I trust him. I told him essentially what i’m telling you today.

It is always your choice. ALWAYS. It is always your responsibility to (quickly) review the consequences of obedience and disobedience and make your own decision. Often, particularly if you trust the person giving you a command and you know that they generally are looking out for your best interests (like your parents), the decision to obey is pretty easy or obvious.

But, as adults, the situations we face are not always so clear. Particularly in the realm of health care. I’ve been surprised at how controversial it can be when a patient asserts her right to make an informed choice, and to make a choice that might differ from what the doctor wants you to do. But, when it comes right down to it, the patient does not HAVE to do what the doctor says. The doctor has no control over the patient. The doctor is, in fact, a hired consultant who works for the patient and is paid by the patient for his/her expert opinion. Just like a plumber. Nobody thinks twice about making their own decisions about their plumbing. But for some reason in this country, we all freeze when it comes to making our own health care decisions.

Throughout this ongoing saga with our baby’s kidney thing (the actual word is like 300 letters long), I’ve struggled with making the right decisions about our care. And I’ll admit – it’s HARD. Because plumbers usually are willing to discuss with you your options; doctors often aren’t. A few months ago, when our MFM consultant wanted us to return in 4 weeks for yet another biophysical profile, she would not really clarify what information we hoped to learn or how that additional BPP would help us, she just kept saying that it was protocol and it was what we needed to do. Yeah, I get that it’s what SHE wanted us to do because it’s what SHE was comfortable with, but there was a reluctance to discuss other options. What if we skip it entirely? What if we delay it by 2 or 3 weeks? What are the risks, and are the risks worth it to give me back some sense of normalcy?

(Ultimately we decided to push it back 3 weeks and I was the happiest I’d been in months.)

I’m not advocating just doing whatever you want, regardless of what is recommended to you. What I’m saying is that often, doctors don’t stop to consider that their patients have brains, too. Our MFM wanted us back in 4 weeks because that was the standard she has in her office, not because coming back in 4 weeks was actually really necessary. Had it been really necessary, I’m confident that our doctor could have defined for me exactly what the need was; she has certainly been able to do so in the past.

When my mom was still alive and dealing with Type I diabetes that had led to retinopathy, kidney failure, and heart problems, she had a long-standing argument with her nephrologist about wanting to do a test that involved drinking the radioactive particles. He really thought the test would give them some good information that would help with better decision-making; she was afraid that the radioactive particles would be more than her fragile kidneys could handle and would push her to needing dialysis, which she had worked so hard to avoid. He was a really awesome doctor and respected her choice, even though he believed it was short-sighted. But they had different priorities, and ultimately he recognized that it was her health, and they were her kidneys. (And when she ended up needing dialysis anyway, one of the first things she did was tell him it was time for that test now.)

It’s too bad we can’t all have doctors willing to entertain these conversations with us, but the sad fact is that we just don’t.

The difficult part about taking control of your own decisions in health care is that the stakes can be pretty high. If I ignore my plumber’s advice, I could be looking at an expensive mess; if I ignore my doctor’s advice, I could be looking at a death. It can be difficult to WANT to take responsibility for those decisions. I’ve had more than one time in the last few months of wanting to call up my midwife and tell her to just tell me what to do so it doesn’t have to be my responsibility any more. They’re big decisions, and it’s so much easier to let the doctor make them for you. I get it.

But I also strongly feel that nobody is going to be looking out for the best interests of ourselves and our families like we are. I am the person with the most at stake here, and I am the person in the best place to be making decisions that affect me and my family. If I make a mistake, I get to live with the consequences, and maybe that’s more difficult than being able to blame someone else for the rest of my life, but it’s also more honest.

And I’m not always so contrary with doctors! I can be quite compliant. But I’m not going blindly do what someone tells me, no matter who they are and no matter what fancy pants initials they have after their name.

(PS, yes, I’m happy to get into a discussion about how I, as a Christian, can possibly say that obedience to authority is not important.)

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