I wasn't talking about paternalism at all. I was talking about professionals being responsible for their outcomes. I'm a pharmacist. I do not force anybody to accept or decline any given treatment. Ultimately it's their choice if they take the medications I dispense or not; if they want an OTC product and I recommend a particular one, it's their choice whether they get that product or not. Where I am on the hook is making sure I educate them properly and dispense their prescriptions properly. I can't make the patient decide what medication is suitable for them, in what dose, and follow appropriate state and federal laws in the dispensing. That's my job. If I screw one of those things up then I am on the hook for it. I have to educate patients properly about their medication. If I fail to educate a patient in a way I should have and there are adverse consequences as a result, I am on the hook for them. It has nothing to do with paternalism. It has to do with a responsibility that I as a professional have, to execute the duties of my position correctly as I have been trained to do, and a patient does not have a corresponding responsibility because they do not have that education or training. Although they do have a responsibility to provide information for me to do my job--I can't flag a drug allergy if they don't tell me about it, for instance--but it's up to me to determine what information I need and collect it. And if someone ignores the advice of a professional, normally the professional isn't considered responsible for the outcomes.
And this isn't limited to healthcare professionals. If you hire a lawyer or an accountant, they had better also take responsibility for the outcomes of whatever service they are providing you.
Yet somehow, midwives are different? These midwives that both Buzzbuzz and I have encountered present themselves as not professionals, not healthcare providers, and ultimately the responsibility lies with the mom. So even if the midwife screws up, she's not on the hook. Of course a patient choosing a particular course of therapy has obligations to fulfill in order to make sure everything comes off correctly, but it's still up to the provider to choose a course of therapy that's appropriate for that patient, educate the patient about it including about what specifically they need to do for their treatment to be a success, monitor the patient to make sure it's going well and make appropriate changes if it isn't. Why are some homebirth midwives ducking this responsibility?