TY - JOUR
T1 - The ethics of consent during labour and birth
T2 - Episiotomies
AU - van der Pijl, Marit
AU - Verhoeven, Corine
AU - Hollander, Martine
AU - de Jonge, Ank
AU - Kingma, Elselijn
N1 - Publisher Copyright: © Author(s) (or their employer(s)) 2023.
PY - 2023/9/1
Y1 - 2023/9/1
N2 - Unconsented episiotomies and other procedures during labour are commonly reported by women in several countries, and often highlighted in birth activism. Yet, forced caesarean sections aside, the ethics of consent during labour has received little attention. Focusing on episiotomies, this paper addresses whether and how consent in labour should be obtained. We briefly review the rationale for informed consent, distinguishing its intrinsic and instrumental relevance for respecting autonomy. We also emphasise two non-explicit ways of giving consent: implied and opt-out consent. We then discuss challenges and opportunities for obtaining consent in labour and birth, given its unique position in medicine. We argue that consent for procedures in labour is always necessary, but this consent does not always have to be fully informed or explicit. We recommend an individualised approach where the antenatal period is used to exchange information and explore values and preferences with respect to the relevant procedures. Explicit consent should always be sought at the point of intervening, unless women antenatally insist otherwise. We caution against implied consent. However, if a woman does not give a conclusive response during labour and the stakes are high, care providers can move to clearly communicated opt-out consent. Our discussion is focused on episiotomies, but also provides a useful starting point for addressing the ethics of consent for other procedures during labour, as well as general time-critical medical procedures.
AB - Unconsented episiotomies and other procedures during labour are commonly reported by women in several countries, and often highlighted in birth activism. Yet, forced caesarean sections aside, the ethics of consent during labour has received little attention. Focusing on episiotomies, this paper addresses whether and how consent in labour should be obtained. We briefly review the rationale for informed consent, distinguishing its intrinsic and instrumental relevance for respecting autonomy. We also emphasise two non-explicit ways of giving consent: implied and opt-out consent. We then discuss challenges and opportunities for obtaining consent in labour and birth, given its unique position in medicine. We argue that consent for procedures in labour is always necessary, but this consent does not always have to be fully informed or explicit. We recommend an individualised approach where the antenatal period is used to exchange information and explore values and preferences with respect to the relevant procedures. Explicit consent should always be sought at the point of intervening, unless women antenatally insist otherwise. We caution against implied consent. However, if a woman does not give a conclusive response during labour and the stakes are high, care providers can move to clearly communicated opt-out consent. Our discussion is focused on episiotomies, but also provides a useful starting point for addressing the ethics of consent for other procedures during labour, as well as general time-critical medical procedures.
KW - Ethics
KW - Ethics- Medical
KW - Informed Consent
KW - Personal Autonomy
KW - Quality of Health Care
UR - http://www.scopus.com/inward/record.url?scp=85148676165&partnerID=8YFLogxK
U2 - https://doi.org/10.1136/jme-2022-108601
DO - https://doi.org/10.1136/jme-2022-108601
M3 - Article
C2 - 36717252
SN - 0306-6800
VL - 49
SP - 611
EP - 617
JO - Journal of medical ethics
JF - Journal of medical ethics
IS - 9
M1 - jme-2022-108601
ER -