Abstract

This is a study which investigates informed consent as applied to obstetrics. It is a clinician/ethicist's attempt to apply the ethical principle of respect for patient autonomy to the real clinical world of informed consent in the modern era. Informed consent is an instructional device. It is basically a process which supplies sufficient information to enable competent adults to give their consent for certain medical or surgical interventions. Chapter One discusses the general concepts involved in this process. Chapter Two explains the notion of respect for autonomy as providing the foundation of informed consent. ;Pregnancy is the only condition in which the treatment of one living entity--the fetus--requires the invasion of another--the pregnant woman. Chapter Three explores this "uniqueness" in the context of informed consent. Chapter Four discusses the potential for any "normal" pregnancy to become high risk. Chapter Five is devoted to prematurity, as this situation might involve additional informed choices. Chapter Six presents cesarean section as a procedure which requires special attention regarding consent. Chapter Seven examines mental competency as a necessary condition for autonomous informed consent. It introduces a method for emergency competency testing, as well as a unique scheme designed to prevent conflicts involving competency issues. In Chapter Eight, the notion of advance directives in obstetrics provides an example of obtaining informed consent in advance. Chapter Nine describes the concept of managed obstetric care as a potential major threat to patient autonomy. Chapter Ten summarizes the previous chapters and adds a final personal commentary