Provision of Information

This patient was very excited to be pregnant with her first child but was not having an easy pregnancy. She is naturally petite and had developed gestational diabetes, which was not detected until 30 weeks into her pregnancy. She was then referred to a specialist obstetrician as her pregnancy was considered high risk. As this new mom had been diagnosed with gestational diabetes, she was more likely to have a larger baby. In her case this was particularly worrisome due to her small frame. She was considered at significant risk of the baby developing shoulder dystocia (the shoulder getting stuck) during delivery. This is a major obstetric emergency associated with short- and long-term neonatal and maternal morbidity and associated neonatal mortality. Although the mom was told that she was having a larger-than-usual baby, she was not told about the risks of her experiencing mechanical problems during labor and she was not told about the risk of shoulder dystocia. This mom had repeatedly expressed concerns about the size of the fetus and about the risk that the baby might be too big to be delivered vaginally but she had not asked her consultant specifically about this risk. During the birth the baby did develop shoulder dystocia. There was a 15-minute delay between the baby’s head appearing and the delivery, and during this time the baby was deprived of oxygen. At a few months old, her son was diagnosed as suffering from severe cerebral palsy, caused by deprivation of oxygen. If the mom had been given the option of having an elective caesarean section her son would have been born uninjured.

  • What information should be discussed with patients prior to consent for a procedure?
  • What if a patient does not ask questions about risks?
  • Can a doctor not disclose information about risks if he thinks that information will be harmful to the patient?

Apply Theory (Specific Professional Healthcare Competencies + Clinical Medical Ethical Principles) to Practice in order to provide Optimal Patient-Centered Care (OPCC)

Clinical Ethics and Law, Second edition. Carolyn Johnston, Penelope Bradbury, Series editor: Janice Ryme