Standard Consent vs. Informed Consent - Mothering Forums

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Old 10-22-2006, 05:39 PM - Thread Starter
 
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On another board, someone posted a physician's blog discussion comparing the benefits/risks of Plastibell, Gomco, and Mogen circumcision methods. One of the doctors made a very telling comment that I think all of us benefit from reading:

Quote:
As family physicians I would be willing to lead a study giving informed consent to parents [I'll show you mine at 2 days if you'll show me yours at 2 days], and ask the average parent to choose which technique they would prefer. If we did a true informed consent about the medical benefits versus risks, they would probably choose neither. However using the standard consent, I imagine there would be a statistically significant preference for the nonPlastibell methods.
This quote blatantly states what we've suspected all along: Doctors are knowingly witholding vital information from parents because they know if they told the whole truth it would greatly influence their choice, and most would choose not to circumcise.

Awhile back, I found the standard consent form for our local hospital's birth center:

http://www.swmedctr.com/documents/Bi...rcumcision.pdf

It shares a single page with the HepB consent.

About the foreskin: It's the "covering that surrounds the end of the penis."

Reasons it's done: Customs, religious conviction, tradition, or "unusual tightness of the foreskin" (phimosis) which they admit "cannot be diagnosed at birth".

Risks: Hemorrhage, infection, trauma, scar tissue.

(Uh, trauma and scar tissue are GUARENTEED, aren't they?)

That's it. Sign on the dotted line if you've discussed it with your doctor and you want the procedure performed on your son. No doubt in many cases this is the ONLY information many parents are provided. Is there any other surgery where so little information is volunteered, and patients (or guardians) are supposed to ASK for the basics? It's so unethical it's ridiculous. Is it any wonder this practice continues?

Here's an example of true, Informed Consent from ICGI for comparison.

Jen
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Old 10-23-2006, 02:46 AM
 
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ICGI is a great example of what should be... but it just is to radical to be accepted.

There are a few examples out there that most hospitals could very easily take on-- and indeed, pressure should be applied to them procedurally.

I'm still on the 2nd pages of posts on this forum today and its 12:30, so I'll try to see if I can find another example later on.

Jessica

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Old 10-23-2006, 06:37 PM
 
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Nocirc also has an informed consent form. Not quite as detailed as ICGI. But still effective!
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Old 10-24-2006, 01:21 AM
 
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How can "doctors" do that in good conscience? (sorry if I spelled that wrong)

It just seems to fly in the face of all that is proper in medical care. What happens to them in med school?
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Old 10-24-2006, 10:28 PM
 
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I work in the health field(student midwife) and used to instruct a program which covered communication issues with nurses, med students and GPs where we covered informed consent. As we defined informed consent (or now as we are starting to refer to it as informed decision making cause informed consent implies you will consent).
The person (or parent/etc) must have all risks and benefits explained to them of both having and not having the procedure in question and be able to completely understand what is being said to them (so no medical lingo and access to interpretters for people of CALD backgrounds) and have the opportunity to ask questions and have them satisfactorily answered.

Now does anyone remember ever having such a thorough discussion prior to consenting?
The thing is when ensuring doctors understand how important informed decision making is patient comfort and wellbeing, yeh sounds nice enough.. when you say how vital it is to be adhered to because of medico legal risks then they start nodding!
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Old 10-27-2006, 10:11 AM
 
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It was me who originally found that blog.

In Australia, if an adult submits to an invasive procedure or surgery without properly informed consent its assault (according to a brochure I saw from the health department). (Hard to police though).

Its likely to be similar in the USA.
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Old 06-07-2007, 01:38 PM - Thread Starter
 
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Old 06-07-2007, 03:11 PM
 
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I like this list of questions one should ask before having an operation:

http://www.facs.org/public_info/operation/consent.html

If the chips are down, the buffalo is empty.

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Old 06-07-2007, 04:37 PM
 
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Quote:
Originally Posted by pdx.mothernurture View Post
On another board, someone posted a physician's blog discussion comparing the benefits/risks of Plastibell, Gomco, and Mogen circumcision methods. One of the doctors made a very telling comment that I think all of us benefit from reading:



This quote blatantly states what we've suspected all along: Doctors are knowingly witholding vital information from parents because they know if they told the whole truth it would greatly influence their choice, and most would choose not to circumcise.

Awhile back, I found the standard consent form for our local hospital's birth center:

http://www.swmedctr.com/documents/Bi...rcumcision.pdf

It shares a single page with the HepB consent.

About the foreskin: It's the "covering that surrounds the end of the penis."

Reasons it's done: Customs, religious conviction, tradition, or "unusual tightness of the foreskin" (phimosis) which they admit "cannot be diagnosed at birth".

Risks: Hemorrhage, infection, trauma, scar tissue.

(Uh, trauma and scar tissue are GUARENTEED, aren't they?)

That's it. Sign on the dotted line if you've discussed it with your doctor and you want the procedure performed on your son. No doubt in many cases this is the ONLY information many parents are provided. Is there any other surgery where so little information is volunteered, and patients (or guardians) are supposed to ASK for the basics? It's so unethical it's ridiculous. Is it any wonder this practice continues?

Here's an example of true, Informed Consent from ICGI for comparison.

Jen
Can you PM me with info on the original board/post that you referenced? Thanks!
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Old 06-07-2007, 04:38 PM
 
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I was somewhere the other day, I can't remember where it was, signing a consent form. I was trying to read it and the guy kept interrupting me and paraphrasing what was in the document. He continually tried to prevent me from "wasting my time" since what was in the document he had already explained. I had to tell him to shut up and leave. He just didn't get why I would want to actually read the legal document I was signing. It was like a personal slight to him or something that I didnt' just trust his word. I wish I could remember where I was.
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Old 06-07-2007, 11:34 PM
 
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Quote:
I was somewhere the other day, I can't remember where it was, signing a consent form. I was trying to read it and the guy kept interrupting me and paraphrasing what was in the document. He continually tried to prevent me from "wasting my time" since what was in the document he had already explained. I had to tell him to shut up and leave. He just didn't get why I would want to actually read the legal document I was signing. It was like a personal slight to him or something that I didnt' just trust his word. I wish I could remember where I was.
Perhaps if the typical circ. consent form WAS that long and technical, people would actually take some time to question.

My understanding is that it is pretty basic... child's name, consent to circ, sign here date-- and doesn't often even include a list of risks or complications.

Jessica

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Old 06-10-2007, 01:44 AM
 
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pdx.mothernurture thanks so much for the link to the movie in your signature.

Circumcision makes me so sick, when I think about it, I feel like I'm being cut with a knife. And to watch so many people of so many cultures celebrate it is beyond disturbing.
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Old 06-10-2007, 01:43 PM - Thread Starter
 
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Quote:
Originally Posted by Nathan1097 View Post
Can you PM me with info on the original board/post that you referenced? Thanks!
I wish I could. I think it may have origionally come up on MT...it was awhile ago, I'm don't think I have a link to the origional source but I can try to search around.

Jen
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Old 06-10-2007, 01:50 PM
 
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http://psotblog.typepad.com/psotblog...stibell_o.html

Now please excuse me while I go throw up.....
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Old 06-10-2007, 02:27 PM
 
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it should be mandatory that *everything* is "super informed consent"
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Old 06-10-2007, 03:39 PM
 
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There's some pretty good comments from consumers at the end of it all.
Sure brought the discussion to a close fast. We've just learned of
another Plasti-bell death in Canada, I'll be posting more on that in the next
few days once we figure out how to handle the matter with the press.
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Old 06-11-2007, 11:20 AM
 
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Quote:
Originally Posted by baybee View Post
There's some pretty good comments from consumers at the end of it all.
Sure brought the discussion to a close fast. We've just learned of
another Plasti-bell death in Canada, I'll be posting more on that in the next
few days once we figure out how to handle the matter with the press.
I will spread the news once you post it.

"Parents are simply trustees; they do not own the bodies of their children"-Norm Cohen  Martial arts instructor intactlact.gifhomebirth.jpgnak.gif and mom to 4: DD1 (1/05) DS (7/06) DD2 (5/08) DD3 (2/11)
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Old 06-11-2007, 11:52 AM
 
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How many people would circ if they listed "death" or "disfiguration" or "loss of penis" on the risk list? Hmmm...
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Old 06-11-2007, 11:01 PM
 
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Unfortunatly, a lot. Very few people discount it entirely. Many just assume there are many factors and mismanagement or neglect that would cause it and that it would never happen to them.

Jessica

Jessica..lady.gifintactlact.gif Falling in love all over again..... 
Dhprivateeyes.gif, Joshua rolleyes.gif Rebeccagrouphug.gifand dog2.gif.    candle.gif for Laura
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