Informed Consent in Obstetric Anesthesia

1. Informed Consent in Obstetric Anesthesia Dmitry Portnoy Anesthesiology Department UTMB

2. OB Anesthesia is a High Risk Area Many patients are healthy individuals High expectations regarding outcome in general both availability and quality of anesthesia Great disappointment if outcome less then perfect Misconceptions re: anesthesia options and risks

3. OB Anesthesia is a High Risk Area High stress and high anxiety environment Public influence on role of anesthesia in L&D Anesthesia care for both fetus and mother Problematic process of obtaining consent Legal remedies for real or perceived injuries

4. Theories of Liability and Medical Malpractice Theories (or causes of action) Medical malpractice Breach of contractual promises Lack of informed consent Four elements for proving medical negligence Duty Breach Injury Proximate cause

5. What is Informed Consent ? Recognized ethical and legal right of every patient for self-determination and direction of health care Elements of full informed consent Nature of the procedure Reasonable alternatives Relevant risk, benefits, and uncertainties of each choice Assessment of patient understanding Acceptance of the intervention by the patient Documentation

6. Establishing Lack of Informed Consent Failure to inform of material facts Patient consented without being aware A reasonably prudent patient under the same circumstances wouldn�t have consented if informed The treatment provided was the cause of injury

7. What is �Adequate� Information? No need for full disclosure of all possible risks Only risks that are reasonably foreseeable required Usually one of three approaches Reasonable physician standards Reasonable patient standard Subjective standard Shown in court as �not significant� risk 0.75% esophageal perforation during endoscopy 1 in 20,000 to 1 in 50,000 is not foreseeable risk

8. Is this Patient Able to Make a Decision? Premeditated patient Patient under stress Patient with known mental illness The immature patient Patient in labor

9. Influence During Informed Consent Process Coercion Manipulation Persuasion

10. Special Situations Capacity/incapacity (=competence/incompetence) Determined by professional judgment or by court State laws delineates who is authorized Decision is consistent with patient�s �best interests� Minor patient is able to consent By state law that permits minor to consent By clinical determination By judicial determination of emancipation

11. Consent for Labor Analgesia No consensus nationwide on signed consent Ideally should be discussed before the labor Obtaining consent during active labor Have a good recall Rarely primary basis for verdict Considered adequate in court Lack of objection and cooperation of the patient