Gaining a person’s consent for medical treatment has to be ‘just right’

AIMS Journal, 2021, Vol 33, No 3

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Vintage illustration by Arthur Rackham
Public domain

By Alex Smith

Chapter one - This one was too lacking.

MIDWIFE (busily writing in the notes): Everything looks perfect. Let’s fit you in for your induction on Thursday, Okay? If we don’t see you before, we’ll see you then!

MURIEL (looking overwhelmed): Okay

Chapter two - This one was too coercive.

MIDWIFE (busily writing in the notes): Everything looks perfect. Let’s fit you in for your induction on Thursday, Okay? If we don’t see you before, we’ll see you then!

MURIEL (looking anxious but determined): I would rather avoid induction if possible.

MIDWIFE (looking and sounding sympathetic): I know it’s not what you want. Fingers crossed; you may go into labour in the next day or two.

MURIEL (taking a deep breath): I have discussed this with my partner. We understand that we could wait a while longer and have extra checks on the baby instead. Wouldn’t that be all right?

MIDWIFE (putting her pen down and taking a deep breath): Yes you could do that but we don’t recommend it because of the extra risks to your baby.

MURIEL (starting to sense the tension): Is it really much riskier?

MIDWIFE (adopting a regretful but firm and matter of fact tone): Sadly, yes. Babies are twice as likely to die if pregnancy goes beyond 42 weeks. We just don’t want to take that risk, do we.

MURIEL (looking browbeaten, Muriel remains silent)

MIDWIFE (standing to see Muriel to the door): So I’ll take that as a yes for Thursday shall I? Try not to worry; it’s all very routine. Have a lovely afternoon.

Chapter three - But this one was just right and the rate of complaints fell through the floor!

MIDWIFE (busily writing in the notes): Everything looks perfect.

MURIEL (smiling): That’s good. I can’t wait to meet the baby.

MIDWIFE (putting her pen down and paying Muriel her full and warm attention): Well, you are 41 weeks now, so that’s going to be very soon.

MURIEL (looking serious): I hope so because I really don’t want to be induced. Some friends have told me it was horrible.

MIDWIFE (matching Muriel’s concern): Yes, I understand. There is a place for induction and we can offer this to you as a routine procedure within this coming week – as soon as Thursday in fact – but you are right, some women do find it very hard-going. In some situations it may be beneficial, but it is an invasive procedure and a process that can stretch over a few days. Would it help if we talked through all your options?

MURIEL (sounding relieved and understood): Yes please.

MIDWIFE (remaining calm and measured, the midwife briefly explains the pros and cons of each pathway – induction, expectant management, and carrying on as before): The decision is entirely yours Muriel. You don’t need to decide now. Go home and talk it through with your partner. I will email you with the research evidence you asked about. This information will enable you to consider the balance of concerns between the different pathways, but it is really important that you only consent to things that, on balance, feel right to you. Whatever you decide you have our complete support, and you can change your mind at any point.

MURIEL (looking calm and confident): Thank you, I feel so much better now – sort of lighter and happier. I feel I can trust you and turn to you no matter what. I will let you know what we decide.

MIDWIFE (standing to see Muriel to the door): That’s perfect. Have a lovely afternoon.