my perspective on informed consent or refusal

I worked clinical labs, and patient care, for many years. I did phlebotomy (venous blood draws), specimen processing, some testing, and some problem resolution with Doctors and Nurses. I worked in both clinics and hospitals. You can pick up a lot of information from these experiences if you make a point to do so (and I did). I also took an ethics course that was instrumental in my approach to patient care.

There were times that I had to draw blood on a patient that refused, either because it was a trauma/code, or because the person had a condition that made them unable to make their own care decisions. Some of these patients would protest during the blood draw.

I cannot express the level of guilt that went along with these draws. I was always very cautious to only draw patients on their own terms, whenever possible. It felt so incredibly wrong to be drawing blood from someone who was asking for it to end. I don’t even hug people without asking first. I had no paternal leanings that caused me to make decisions on behalf the patient “for their own good”. To do so would be dehumanizing.

Sometimes patients, who were competent to decide their own care, would ask for the draw to end before all the tubes were filled. I asked if they were sure, and if they were sure then the draw would end. They are human beings, after all. What right do I have to tell them that I should keep drawing their blood when they do not want me to? 

This is how I was trained, and how all phlebotomists are trained to limit liability. There are different kinds of consent depending on procedure, but people can easily revoke their consent if it was implied or verbal. It works a lot like sexual consent in that sense. Lawsuits can, and do, result from blood draws being done without patient consent. Its considered a civil case of battery if a phlebotomist, for instance, decided to draw blood from someone who was asleep. Here is a synopsis from findlaw:

Medical battery is the intentional violation of a patient’s right to direct their own medical treatments. Doctors must obtain a patient’s informed consent when rendering non-emergency treatment. If medical treatment is performed without the patient’s consent or against their will, the patient may have a claim for medical battery, even if the doctor did not intend to cause any harm.

In a medical battery claim, there is generally no need to prove injury or negligence. However, as in all battery cases, it is necessary to prove that the medical personnel engaged in unauthorized touching, contact or handling of the victim.   

It is hard to retain an attorney for these cases because the damages are often lower than their fees, but some wealthy people make a point of suing because of how disgusted they are with the violation of their person. I wish this option was open to everyone, because I have a feeling that these violations are more commonly enacted on marginalized people to begin with. Many people aren’t even aware that they are allowed to refuse if they want to.

I sincerely wish that it were easier to sue or reprimand health care workers who violate their patients rights, but it is very hard. I am convinced that the hospital whose attorney approved a forced c-section did so because the cost of a battery suit was likely less than the cost of a malpractice suit if the newborn was injured by refusal of a c-section. Something needs to be done to remedy this flaw in the system. 

I am continually in awe of midwives who seem to think that sticking your hand in someones vagina should require less etiquette and respect than I gave to patients during a blood draw. I cannot imagine continuing a pelvic exam on someone begging for it to stop. I would feel like a rapist. I think most decent people would. No one is entitled to another persons body, ever. 

What is wrong with these women, that allows them to think its acceptable to do this to people? I’ve written before that midwives who advocate natural child birth often seem to become hardened to seeing women in unbearable pain. Perhaps the midwifery attitude of “I know best” goes with the same territory. That was certainly the opinion of a woman who lost her baby to valerie el halta’s methods:

But rather than the “natural” childbirth she expected, Rose said El Halta subjected her to unwanted interventions. Without warning, she “stripped the membranes” — a procedure to separate the amniotic sac from the wall of the uterus and stimulate labor, Rose said.

“It was rough and painful, and she brings her bloody glove back out. ‘I figured I’d just help you along,’ she said. That was her attitude: Auntie Val knows best.”

….

“It was the single most painful thing Val did during my birth,” Rose said. “She had both of her hands inside me. I was yelling at her to get them out, but she refused because she was helping. If someone has two hands in you, and you’re telling them no, and they don’t stop — that’s why I call it a rape.”

This will continue to happen as long as other midwives accept it and do nothing to keep it from happening. 

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