I had a shock when the emergency unit wheeled in a patient into my operation theater.
"She needs a cesarean section for previous cesarean section and meconium in amniotic fluid now" the emergency unit Registrar told us. The patient was a long way from a normal delivery and there was this indication of fetal asphyxiation. She needed a cesarean section. That was standard obstetrics. The shocking thing was yet to come.
"The boss of the parent unit (with whom the patient was registered) wants a sterilization operation performed on her if this baby is a boy, and a copper-T inserted if it is a girl" I was told. That was the shocking thing. To consolidate the shock, they had attached two consents from the patient - one was for sterilization and the other was for copper-T insertion."
"We cannot do that" I said. "Get the parent unit Boss to talk to me."
I discussed the issue with my people in the meantime.
"What do we do if the baby comes out depressed, even if it is a male?" my Assistant Professor said. "Do we still sterilize her? What if the baby dies afterwards? And what if the baby has ambiguous genitalia? If we cannot determine if it is a boy or a girl, what shall we do?"
Everyone laughed.
"We cannot have a conditional consent. The patient has to give a consent prior to the operation. If she cannot, it shows she is not mentally prepared. She needs further counseling" the other Assistant Professor said.
"That is right" I said. "You are good."
"But this unit always does that. It is their unit policy" someone said.
"What do they do with the other consent? Tear it up after the operation? Or do they keep both the consents on the patient's file?" I asked. No one knew the answer.
The parent unit Registrar called us. I asked her to get her boss on the phone. She could not. I waited. Finally the said boss turned up in my OT. I explained our stand to him. Then I also said,
"The patient and her relatives are required to identify the sex of the baby after looking at it. How is an anesthetized woman going to do that and give advise on what to do?"
"You operate with your eyes closed?" he asked. He made up in guts what he lacked in wisdom, I thought.
"Legally we cannot do identification of sex of the baby, and an anesthetized woman cannot do that too. I thought you would know that as a senior Professor."
"You are very adamant as a head of the department" he said. I had the same thought about him that I had had a few seconds ago.
"I am not saying all this as the head of department" I explained. "I am speaking as a head of unit working in this OT today, whom you are asking to do something illegal, for which I will remain liable. I won't do it. If you want, you come into my OT and do it."
He backed out totally and went away. I understood why he had not signed the advice he had given for his patient, but had asked the emergency unit to just write it. I also understood why he wanted a third party to do something that he was unwilling to do himself.
We counseled the patient and her spouse, and they understood the matter. They decided not to have a sterilization operation with the cesarean section.
Later I took an opinion poll on this matter as an academic exercise, without giving out any personal specifics. All heads of units unanimously said they would not accept such conditional consent and would not sterilize the woman.
"We cannot take a conditional consent. There is no provision for that on the consent form prescribed by the government. If we take consent for sterilization and do not perform it, what reason do we give for denial of sterilization on the consent form" one of them asked. "We cannot say it is because the baby is a girl. Furthermore, if we do not sterilize her, she can sue us later for not doing so despite her wish and consent to do so."
"Why did you ask us this?" another unit head asked me.
"There was a situation" I said briefly. "I asked you because I had to know what my faculty think. After all, your students will learn what you teach and practice. If they learn this, their future could be very bleak, if they get involved in a medicolegal case on this issue."
"Another point of concern is that if a person who believes this becomes, examiner, he/she will fail students who believe otherwise" another Professor said. I nodded. It had occurred to me too.
Update:
I checked. They take two consents and then tear one up. It is also heard that if they take one consent with two options, they rub out one afterwards. I am aghast.
"She needs a cesarean section for previous cesarean section and meconium in amniotic fluid now" the emergency unit Registrar told us. The patient was a long way from a normal delivery and there was this indication of fetal asphyxiation. She needed a cesarean section. That was standard obstetrics. The shocking thing was yet to come.
"The boss of the parent unit (with whom the patient was registered) wants a sterilization operation performed on her if this baby is a boy, and a copper-T inserted if it is a girl" I was told. That was the shocking thing. To consolidate the shock, they had attached two consents from the patient - one was for sterilization and the other was for copper-T insertion."
"We cannot do that" I said. "Get the parent unit Boss to talk to me."
I discussed the issue with my people in the meantime.
"What do we do if the baby comes out depressed, even if it is a male?" my Assistant Professor said. "Do we still sterilize her? What if the baby dies afterwards? And what if the baby has ambiguous genitalia? If we cannot determine if it is a boy or a girl, what shall we do?"
Everyone laughed.
"We cannot have a conditional consent. The patient has to give a consent prior to the operation. If she cannot, it shows she is not mentally prepared. She needs further counseling" the other Assistant Professor said.
"That is right" I said. "You are good."
"But this unit always does that. It is their unit policy" someone said.
"What do they do with the other consent? Tear it up after the operation? Or do they keep both the consents on the patient's file?" I asked. No one knew the answer.
The parent unit Registrar called us. I asked her to get her boss on the phone. She could not. I waited. Finally the said boss turned up in my OT. I explained our stand to him. Then I also said,
"The patient and her relatives are required to identify the sex of the baby after looking at it. How is an anesthetized woman going to do that and give advise on what to do?"
"You operate with your eyes closed?" he asked. He made up in guts what he lacked in wisdom, I thought.
"Legally we cannot do identification of sex of the baby, and an anesthetized woman cannot do that too. I thought you would know that as a senior Professor."
"You are very adamant as a head of the department" he said. I had the same thought about him that I had had a few seconds ago.
"I am not saying all this as the head of department" I explained. "I am speaking as a head of unit working in this OT today, whom you are asking to do something illegal, for which I will remain liable. I won't do it. If you want, you come into my OT and do it."
He backed out totally and went away. I understood why he had not signed the advice he had given for his patient, but had asked the emergency unit to just write it. I also understood why he wanted a third party to do something that he was unwilling to do himself.
We counseled the patient and her spouse, and they understood the matter. They decided not to have a sterilization operation with the cesarean section.
Later I took an opinion poll on this matter as an academic exercise, without giving out any personal specifics. All heads of units unanimously said they would not accept such conditional consent and would not sterilize the woman.
"We cannot take a conditional consent. There is no provision for that on the consent form prescribed by the government. If we take consent for sterilization and do not perform it, what reason do we give for denial of sterilization on the consent form" one of them asked. "We cannot say it is because the baby is a girl. Furthermore, if we do not sterilize her, she can sue us later for not doing so despite her wish and consent to do so."
"Why did you ask us this?" another unit head asked me.
"There was a situation" I said briefly. "I asked you because I had to know what my faculty think. After all, your students will learn what you teach and practice. If they learn this, their future could be very bleak, if they get involved in a medicolegal case on this issue."
"Another point of concern is that if a person who believes this becomes, examiner, he/she will fail students who believe otherwise" another Professor said. I nodded. It had occurred to me too.
Update:
I checked. They take two consents and then tear one up. It is also heard that if they take one consent with two options, they rub out one afterwards. I am aghast.
