1.19.2010

Cesarean Consent Form

This clever mama* came up with this consent form after being repeatedly denied a VBAC by OB's in her area. I think this is wonderful! If we have to sign their consent forms they should have to sign ours! What do you think your OB would say to this?
I, the undersigned physician, have, in violation of the Consumer Bill of Rights and Responsibilities, the Emergency Medical Treatment and Active Labor Act, the Patient Self Determination Act, the ethical guidelines of the American Medical Association and the American College of Obstetricians and Gynecologists, Constitutional Law (the right to privacy and self determination protected by the 1st and 14th amendments), international tort law, and case law (of particular interest “In re A.C.”, 1987, “In re Fetus Brown, 689 N.E.2d 397, 400 (Ill. App. Ct. 1997)”, and “In re Baby Boy Doe, 632 N.E.2d 326 (Ill. App. Ct. 1994)”) and the Patient Rights as determined by this institution, deprived my client,________________, of her right to self determination and her right to bodily integrity by ignoring her repeated refusal for delivery by repeat cesarean section. I acknowledge that by refusing to honor my client’s denial of consent, I have not only violated the above laws, but I also affirm that I have used unwarranted and unethical pressure including emotional threats to my client’s and her unborn child’s life and safety, in my attempts to obtain such consent. I further affirm that I have stressed the risks of vaginal birth after cesarean, but neglected to inform my patient of the risks of delivery by repeat cesarean section. I further affirm that I understand, that should I resort to physical force, including but not limited to physical or chemical restraints, to compel my client’s cooperation, I will be guilty of criminal battery, which is defined as “any form of non-consensual touching or treatment that occurs in a medical setting”.
In compensation for the above violations of my client’s rights, I hereby guarantee the following:
  • a healthy baby, born in perfect condition, with no physical, mental or developmental defecits whatsoever, whether arising from surgery or any other cause
  • no complications for the infant, including but not limited to: persistent pulmonary hypertension, transient tachypnea of the newborn, respiratory distress syndrome, iatrogenic prematurity, lacerations, or hematoma
  • a speedy, uncomplicated post-operative recovery for my client. Specifically, I guarantee that my client shall not experience nerve damage, organ damage, hemorrhage (whether sufficient to require transfusion or not), disability or disfigurement, intraoperative or postoperative infection of the wound or surrounding skin and tissues, post partum depression and post partum post traumatic stress disorder (PTSD), and other conditions not listed here.
Signed,
_______________________________________________

*with a blessing from the author, please feel free to use, distribute, or copy this form with the instructions below


For use in the classroom setting or other print-out, please credit “T.G. Perg”.

And don’t forget to leave plenty of kudos and Thank You’s in the comments section for the author of this brilliant consent form.

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