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Informed Consent

Everyday we face choices. Even ordering water at a restaurant can be complicated with sparkling or still, lemon or not, room temperature or chilled... you get the idea. Maybe sometimes we might appreciate having a few decisions taken out of our hands. Maybe it might be nice to just sit back and let someone else make a few of the hard choices for us. Or maybe not.

What is Informed Consent?

Typically the concept of "Informed Consent" has to do with a medical procedure or treatment. It is the legal procedure necessary to ensure that a patient knows all of the risks and costs involved in an offered treatment for their specific diagnosis. Basically, the patient needs to be told of what the treatment will entail, the potential risks versus the expected benefits, as well as if there are possible alternatives and what the risks and benefits would be should they choose an alternative.

In all cases the patient must be competent and coherent to make decisions and the consent must be voluntary in order to be considered valid.

Informed Consent and Pregnancy

There are a lot of decisions to be made when pregnant; for instance, what kind of prenatal vitamin to take, find out the sex or wait - this list goes on and on. While these may seem like big decisions, they really are inconsequential when compared to the really big decisions like home birth or hospital (or something in between), natural birth or not, doula or not, episiotomy or not. Yes, these are all decisions that you can make.

Research has begun to show that much of what women have been told for years regarding standard procedures during pregnancy and delivery have been misunderstood, misconstrued or outright myths.

Take as an example the episiotomy, a procedure that enlarges the vaginal opening during childbirth by making an incision in the skin between the vaginal opening and the anus. The argument in favor of this procedure is that it's better to make the incision than allow the skin to potentially rip, causing a tear that would be more difficult to repair. Supposedly episiotomies help women avoid incontinence and can improve their sex lives following childbirth.

A study published in the Journal of the American Medical Association showed that this is absolutely not

the case; these are all myths. Episiotomies have no affect on any of the above. Additionally, the cut is generally deeper than the width of a large paperclip and about as long, whereas tears (when they do happen) are often small and do not require stitches.

Avoiding Pregnancy Procedures

Medical procedures should require informed consent but they don't always. Many times the situation leaves room for a doctor to make what they feel is a "medically necessary" decision without your consent. For example: breaking your water; inserting an epidural; or using forceps, the vacuum extractor or other means to deliver the baby. That's why it's

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"Informed Consent is the procedure necessary to ensure that a patient knows all of the risks involved in a treatment."

important to have a doula or birth advocate, especially when giving birth in a hospital.

Delivery is an emotional, albeit exciting time during which your feelings and choices may be overlooked. A birth advocate or doula can make sure that your choices, your informed choices, are respected.

A professional doula can even help you prepare by discussing the situations that may arise during your delivery and make note of what your decision would be in each of those scenarios.

Informed Consent and Vaccinations

This has become quite the controversial topic in recent years. As studies have been published linking autism to the MMR vaccine and then refuted with other studies, the topic of informed consent has become a delicate issue.

The right to voluntarily consent to (or decline) vaccinations should be as human a right as any other

we take for granted. Considering the information provided by a pediatrician, and then deciding whether or not to inject our child with a chemical to try to create an immunity to an infectious disease, should be a choice. In many countries it is and in many countries it is not.

Currently, in the United States there are only 18 states that will allow a parent a philosophical, personal or conscientious belief exemption to vaccination, and recently one of those states, Washington, passed a law that said the parent must get a medical doctor to "sign off" on that exemption. Without this exemption, a child must be vaccinated in order to enter the public school system, making vaccinations compulsory in 32 states. The purpose being a theoretical possibility called herd immunity; vaccinate everyone and those that can't be vaccinated will be protected by the immunity of the rest of the "herd".

The UK and Canada do not require vaccination but they have a similar immunization schedule to the United States and United Kingdom. What is this schedule? Three times the number of vaccines given to children in the early 80's.

The average child is expected to receive nearly three dozen doses of more than a dozen vaccines.

Immunization Choices

Informed consent is just that, the right to make an informed choice regarding what is best for you and your children. This should include vaccinations, and in some places it does but for how long? While the herd mentality of herd immunity continues to grow, it whittles away at our basic human right to choose for ourselves what we're going to have done to us and our children.

Informed Consent and You

What it boils down to is this: do we really live in a free society? Can we actually make our own healthcare decisions? The American Medical Association says, "Informed consent is more than simply getting a patient to sign a written consent form. It is a process of communication between a patient and physician that results in the patient's authorization or agreement to undergo a specific medical intervention."

Sure that sounds like it's putting the power in our hands but notice the wording communication "that results" in the patient's agreement. The end result is agreement, not understanding or acceptance. Yet, the right of the patient should be to decide for themselves; not to be talked into something, but to be given all the information and then allowed to make their own decision based on the data presented.

Informed consent should be an educated decision.

Proactive Steps

  1. Ask for the risks and benefits to be provided in writing for your review prior to agreeing to any procedure, etc.
  2. Wait to perform any procedures until you have time to go home and research it in more detail. For instance, find the opposing opinion prior to deciding whether or not to have a procedure or choose an available alternative.
  3. Remember that you have complete control over your healthcare and can walk away from a relationship with a provider at any time. The decisions are yours to make. You should never feel powerless in a healthcare relationship.

For more information...

NVIC.org - National Vaccine Information Center

www.americanpregnancy.org - American Pregnancy Assn.

www.dona.org - Doulas of North America

www.birthingbetter.com - Birthing Better

www.icpa4kids.org - ICPA Website for Parents

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Dear Patient,
Dr. Cohn is dedicated to providing you with the absolute best in family wellness care. So take a moment today to discuss with your Family Wellness Chiropractor any concerns you may have regarding your family's overall health and wellness.

 This newsletter is provided to you by:

Dr. Ari Cohn
33 State Road, Suite B
Princeton, NJ 08540
609.683.3996
www.PrincetonChiropractic.com