Oral Presentation Australasian Association of Bioethics & Health Law and New Zealand Bioethics Conference

Max Charlesworth Prize Winner: Isn’t it a woman’s prerogative to change her mind? The ethical issues of requesting medical intervention in labour for which consent had previously been declined (1000)

Katie Ben 1
  1. Department of Anaesthesia, Nelson Marlborough DHB, Nelson, New Zealand

The management of pain in labour consists of a spectrum from non invasive, non pharmacological treatments (aromatherapy, warm water immersion, massage), through to pharmacological treatments (opioids, inhaled nitrous oxide) and finally to invasive pharmacological methods (epidural analgesia with the administration of local anaesthetic agents into the epidural space near the spinal nerve roots). While largely safe, epidural analgesia is not without risks, in some cases significant risks, albeit with very infrequent incidence. Insertion of an epidural for the relief of labour pain is therefore subject to the same clinical guidelines regarding informed consent as other medical interventions.

This essay will look at the ethical issues and difficulties that clinicians face when patients change their mind having previously declined an intervention. I will start with a case description (based on a number of clinical experiences throughout my career as an anaesthetist) and then explore the ethical concepts of autonomy and the ability to give informed consent which are highlighted. I will argue that the patient was able to give informed consent to a decision regarding a medical procedure while in pain using a syllogism analysis. In terms of the question regarding respect for autonomy, I will argue that the patient made two autonomous decisions at different points in time and that, while contradictory, both autonomous decisions were respected at the times they were made. I will also briefly suggest how such a situation could be avoided to the benefit of both patient and clinician in the future.