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Landmark decision for patient rights in Caesarean case

MagazineJuly 1998 (Vol. 9 Issue 4)Landmark decision for patient rights in Caesarean case

Early in May, in a landmark decision, the British courts struck a blow for patient rights

Early in May, in a landmark decision, the British courts struck a blow for patient rights. The Court of Appeal held in favour of Ms S, a woman who had been forcibly given a caesarean section against her will.

The court decided that the South London hospital and a social worker had acted unlawfully in having the woman, a veterinary nurse, declared mentally unfit because she'd refused her doctor's advice. Ms S's GP advised her to undergo a caesarean during her eighth month of pregnancy after discovering she had pre-eclampsia. When she refused, the hospital detained her by sectioning her under the Mental Health Act, then transferred her to a maternity hospital where she was sedated and operated on against her will.Ms S had made it clear, verbally and in writing, that she'd wanted a home birth, no matter what the consequences were.

The appeal judges ruled that the forced caesarean amounted to a violation of trespass and that a pregnant woman is entitled "not to be forced to submit to an invasion of her body against her will, whether her own life or that of her unborn child depends on it". To do so, "even for the most laudable of motives", they wrote, "irredeemably" damages the "principle of self determination".

The ruling now clearly establishes that women have the right to choose the way in which their children will be born, regardless of what their doctors think regardless of whether it flies in the face of accepted medical opinion, or, as the judges put it, "no matter how bizarre or irrational". This should put an lid on women being browbeaten into caesareans or refused home births.

Many in the medical community, particularly those in the Right to Life camp, worry, as does Janet Radcliffe-Richards, a former member of the Ethics Committee of the Royal College of Obstetricians and Gynaecology, that the decision concerns "the extent to which any parent should be allowed to damage any child and the extent to which the rights of the parent should prevail over the rights of the child".

I have to quarrel with this notion that a doctor's opinion of the appropriate medcial procedure in a case like this constitute's a child's right since it assumes that the doctor's view of the situation is always the correct one.

The ruling underscores that patient autonomy is supreme. It should sharply curtail the number of cases in Britain where the Mental Health Act is shamefully employed to declare an individual incompetent and detain him against his will, simply because he disagrees with his doctor. It more firmly establishes the patient as a medical consumer, whose doctor's responsibility and involvement ends when a competent patient rejects his services.

The ruling may also lower the ever increasing power of family court judges to determining the best medical treatment for an individual, which, as one knowledgeable barrister pointed out, nearly always amounts to backing up the doctors in the case.

It is too soon to tell whether this ruling may give parents ultimate say over their children's health, on issues such as vaccination.

However, it can be no accident that just two weeks after the ruling, the General Medical Council announced that doctors will be struck off if they fail to tell patients the truth about their treatment. Previously, according to law, patients had the right to the truth, so long as the doctor believed it was in their interests to know a fairly elastic condition which allowed doctors the latitude to disclose whatever they liked.

This new ruling by the GMC means that, henceforth, if a doctor doesn't tell you the truth, even about procedures like vaccination, you have a very good chance of taking an action against him for failure to obtain your informed consent.

At long last, the ball is moving back in our court.


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