An Analysis of the Challenges Encountered by Anaesthetists when Obtaining Consent for Obstetric Epidurals
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Obtaining informed consent for obstetric epidurals is a complex area of anaesthesia. Practice among obstetric anaesthetists in this jurisdiction is widely varied. This paper provides an analysis of the ethical and legal challenges encountered by anaesthetists when endeavouring to obtain informed consent to administer the obstetric epidural and makes recommendations as to how these challenges might be lessened.
A systematic review of research papers sourced from relevant data bases and websites was conducted. Direct inquiries were also made with three Dublin Maternity Hospitals regarding the practice of obtaining consent for epidurals as well as with the State Clams Agency regarding the incidence of litigation in this area.
The study demonstrates the onerous legal duty now placed upon clinicians when obtaining informed consent as well as the ethical quandaries that can arise. The legal expectation is that the clinician has or ought to have an awareness of the risks associated with any given procedure / treatment which his patient will attribute significance to and that his patient will be advised accordingly. This presents challenges in the context of the administration of the obstetric epidural including ethical dilemmas, demands on resources, moral distress and potential litigation.
In order to lessen the incidence of such challenges the following recommendations are made:
A national standard governing the process of obtaining informed consent to obstetric epidurals is implemented across the nineteen public maternity units in this jurisdiction.
This includes the introduction of a nationalised patient information card regarding obstetric epidurals which is first presented in the antenatal period and re-introduced on admission for delivery.
Ante-natal classes includes a class given by the obstetric anaesthetist regarding the effects, side effects and risks associated with obstetric epidurals.
Obstetric anaesthetists are provided with better guidance from their professional bodies in respect of the doctrine of informed consent.
Annual group sessions with an ethicist and a medico-legal specialist whereby anaesthetists gain better understanding of their legal and ethical obligations in this context should also be facilitated.