Friday, August 27, 2010

Court ordered medical treatment for pregnant woman in the US

Informed consent and right of refusal are accepted legal concepts. The woman has the right to make informed decisions, including consent or refusal of any aspect of her care. The courts have consistently affirmed that the autonomy of the individual prevails, even when a patient refuses to consent to life-saving treatment.

Autonomy; Even when his or her own life depends on receiving medical treatment an adult of sound mind is entitled to refuse it. This reflects the autonomy of individuals and the right to self you will read from Judge Butler-Sloss in the St George’s Healthcare NHS Trust case where a woman was forced by a court order to have a caesarean section against her will...... You could liken this to the current issues surrounding women making a choice to have a ‘Homebirth’..... and doctors applying pressure and creating a ‘fear’ culture to ensure that women choose hospital as opposed to homebirth.....

Judge Butler-Sloss in St George’s Healthcare NHS Trust v S (1999) “...while pregnancy increases the personal responsibilities of a woman it does not diminish her entitlement to decide whether or not to undergo medical treatment. Although human and protected by the law in a number of different ways..., an unborn child is not a separate person from its mother. Its need for medial assistance does not prevail over her rights. She is entitled not to be forced to submit to an invasion of her body against her will, whether her own life or that of her unborn child depends on it. Her right is not reduced or diminished merely because her decision to exercise it may appear morally repugnant.,....”.

Now in the US where the fetus has arguably had more rights than its mother in some states, which in my opinion is outrageous the State of Florida has recently ruled that a woman who refused medical treatment was ordered to comply with her doctor’s orders. The woman a mother of two who was experiencing complications during her pregnancy was ordered to hospital, made to receive medical treatment and have a caesarean delivery.

“The trial court ruled that the woman's refusal of medical treatment placed her pregnancy at high-risk and created a "substantial and unacceptable" risk to her fetus. The trial court said the state's interests in protecting the fetus superseded the woman's privacy interests, and she was ordered to comply with her doctor's orders. The woman submitted to hospitalization, medical treatment and a caesarean delivery, although the fetus was delivered stillborn.”

The case went to appeal and the decision was overturned......

“In its ruling, the appeals court said the state's interest in the life of the fetus becomes compelling only when the fetus reaches viability, as outlined in the 1973 U.S. Supreme Court ruling on Roe v. Wade. The court added that there was no indication of viability when the trial court ordered medical treatment and that even if viability were shown, the trial court applied the wrong legal test. The "test to overcome a woman's right to refuse medical intervention in her pregnancy is whether the state's compelling interest is sufficient to override the pregnant woman's constitutional right to the control of her person, including her right to refuse medical treatment," the court said in its ruling. It added that the state also must show that its method of pursuing the compelling state interest is narrowly tailored to protect the woman's rights”.

However for this woman her rights have been totally obliterated..... mind you this case now becomes another precedent and hopefully some other woman does not have to go through the same ordeal. We have to remember that women have the right to self determination; because they are pregnant they do not lose that right.

We in Australia have to be mindful that this does not happen here, that women’s right to self determination is not eroded such as this.

“The American Civil Liberties Union, which filed a friend-of-the-court brief in support of the woman, said in a statement that the ruling is "an important decision for the right of women to make their own medical choices." Diana Kasdan, a staff attorney with the ACLU Reproductive Freedom Project, said that women "do not relinquish their right to determine their own medical care when they become pregnant."


St George’s Healthcare NHS Trust v S [1999] Fam, 26’ [1998] 3 All ER 673

Wednesday, August 18, 2010

Deciding who to vote for?

Deciding who to vote for?
The Australian election is on Saturday and it is down to the will be a close call. What is it that makes you decide who to vote for? This election I have been more political than ever before...why is this? Because women and midwifery matter and now more than ever I feel that my vote counts more than ever. The recent battle for the profession of midwifery is almost equal to what women went through to get the vote (the SUFFRAGETTES)... equal rights the right to choose how to birth, the right to refuse treatment also more importantly the right to informed choice & continuity of care of a known midwife.

Your vote matters.......

We know who the major parties are; Labor; Liberal and Greens; over the years I have fluctuated between all the parties and in the days of Democrats, I was a staunch supporter. I will decide on Saturday.......and I will VOTE!

I do believe that the Labor Party Nicola Roxon as Health Minister has truly broken boundaries and put midwives, midwifery & nurse practitioners on the map..... however her latest Determination of 2010 has seriously let us down...and yes I can see that the AMA played a large part in this equation immediately prior to an election.... you are going to do what you think will get you re-elected.... however the Determination is seriously flawed and will not work for women, midwives or obstetricians and they the doctors currently hold the balance of that power, this is un-Australian..... midwives are currently regulated and do not need to have Dr’s veto their practice in order to claim a Medicare rebate.....I do feel that the Labor party are aware of this problem now and will change it if re-elected......

I am willing to give the devil I know another chance as opposed to the devil that is worse......a chance to prove it is worse... but will decide on the day....

On the other hand Liberals Tony Abbott has notoriously ignored the plight of midwives and our colleague nurses, a female dominated profession. He is a staunch Catholic therefore Pro life and not Pro Choice.....Tony Abbott’s history as Health Minister speaks for itself...non productive... and I am not so sure he is compassionate in terms of refugees......I wonder if he is promising to reduce the surplus where are we going to pay for it?.....

The problem with elections is that we get so many promises we end up not knowing who to believe......I would not want to be a politician...

The Greens Rachel Siewert....The "Australian Greens said today that midwives are furious with the Federal Government over recently released regulations governing the way they practice".
......The Greens are great supporters of midwives they are the only party that has a Homebirth policy and that have put women, midwifery and midwives openly on the agenda..... and it is very important that they control the senate to keep the bastards honest.....and maybe control the balance of power.......

Issues are numerous..... Refugees; Work Choices; Health; Education, Surplus, and the list goes on.... my message is don’t waste your vote...... if neither of the major parties don’t do it for you then vote for Greens or an Independent.... but vote because it matters.

Tuesday, August 10, 2010

Legal issues? Homebirth again!

The Medical Observer writes Homebirths GP's new legal dilemma.... "If your patient decides on a midwife-led home birth and asks for prescriptions, could you be legally liable if something goes wrong?"
sometimes I am still amazed at what the AMA will come up with next..... really it should be no surprise that this tactic would be used.....
"Midwives are able to legally administer Syntocinon but cannot prescribe it, until 1 November when changes to federal laws mean nurse practitioners will have limited access to the MBS and PBS."
Giving syntocinon has always been part of a Midwives role, this drug is not new to the is part of our job, however the drug is only used if there is postpartum hemorrhage.
Part of a midwives course is a detail pharmacological unit, which entails knowing about the drugs used within midwifery there use and contraindications of drugs..... the way this article reads is as if this is a new drug that midwives have no idea about.....midwives are trained professionals.
According to Homebirth Australia spokesperson Justine Caines, the group has had reports of women in the ACT, NSW, Queensland, Victoria and SA who have been refused scripts for Syntocinon, vitamin K and ultrasound referral by their GP.

She says there is a steady growth in home birth as more women become what she calls “refugees” from the hospital system, reluctant to return for another birthing experience of “substandard or unsafe care”.

Ms Caines condemns the decision to refuse women these scripts and believes GPs are being unnecessarily cautious.

“I think [GPs] have less to fear than when they normally prescribe, as in this case the woman is in the care of a registered midwife,” she says.
Indemnity insurers are not so confident. There are legal risks for GPs if they do choose to prescribe painkillers, vitamin K or Syntocinon to patients wanting a home birth, they say.
Cheryl McDonald, medico-legal manager at MIGA (which will handle the new Midwives Insurance Scheme) says GPs are quite within their rights to refuse to write scripts in the case of home births, where they have no control over the medical outcome.

This really makes a mockery of the Collaborative arrangements Determination 2010....and really begs the question, how well thought out was the collaborative arrangements....? and did the AMA plan this all along knowing that these arrangements would not be workable. I am all for good collaborative arrangements that are workable, fair and equitable, not power orientated.

As midwives we have to be as proactive as the AMA..... we need to be allowed to practice our profession just as they are......this is about monopoly, money and power.
We need to be considering "women's choice" fairness and equity and right to refuse....

ref pic:

Saturday, August 7, 2010

"Greens Will Act to Help Midwives Media Release"

Read what the Greens have to say about “the collaboration determination”

Greens Will Act to Help Midwives Media Release | Spokesperson Rachel Siewert Saturday 24th July 2010, 10:01am

The Australian Greens said today that midwives are furious with the Federal Government over recently released regulations governing the way they practice. Greens spokesperson for Health, Senator Rachel Siewert has committed to immediate action on the regulations upon the resumption of Parliament.

“As soon as the Senate next sits, the Greens will move a motion to disallow the collaborative arrangements regulation,” Senator Rachel Siewert said today.

“This regulation puts doctors in total control of midwives and makes a mockery of the Government's $120 million “Medicare for Midwives” reforms,” said Senator Siewert.

“The government released its definition of collaborative arrangements for midwives out of parliamentary session, and it’s easy to see why- their approach is unacceptable and demeaning to midwives and they didn't want to draw attention to them during the last week of sitting.

“Midwives are concerned that this determination effectively means that if a doctor does not agree with a woman’s choice of midwife, they do not have to participate and will withdraw their collaboration.“Midwives will have to work under the control of a doctor in order to access Medicare payments.

They must have a signed agreement with a doctor who agrees to the way they are providing care or have all elements of care planning acknowledged at every step.“We’re speaking about trained and regulated professionals who have been insulted by the reforms put forward.

“If the government does not trust regulation of health professionals to ensure that practitioners are working safely, it is a very sad indictment of their own health care system.

“The government has failed to deliver anything like the promises they made for midwifery reform and at the same time have given power of veto of one medical profession over another.

"Women are outraged that they have been told that Medicare rebates will be available for private midwifery care and now the reality is that this will be limited to those employed in an obstetric model which many women have said over and over again that they don't want," concluded Senator Siewert

Thursday, August 5, 2010

Working as an Private Practice Midwife with the new legislation:

As from the 1st July 2010 all of Australia except for WA has joined National Registration (AHPRA) and therefore requiring indemnity insurance when registering as a Midwife, or Nurse Practitioner. WA is expecting to join National Registration in mid October 2010, until then the Nurses and Midwives Act 2006 applies.

There are a few ways in which this can be achieved in Australia with the new Collaborative Arrangements: If you are already in private practice/independent you can use the exemption clause from the Health Practitioner Regulation National Law Act 2009 s284 (Exemption from requirement for professional indemnity insurance arrangements for midwives practising private midwifery)

During this time the midwife does not contravene section 129(1) which states you need private indemnity insurance to be registered. However the midwife must ensure that he/she has a signed consent form from the woman in relation to having no insurance. However you need to be mindful of 284(1)(c)i “the midwife complies with any requirements set out in a code or guideline about reports to be provided by midwives practising private midwifery; and(ii) any requirements in a code or guideline relating to the safety and quality of the practise of private midwifery.
Codes to note: New Code of Ethics for Midwives August 2008: New Code of Professional Conduct for Midwives August 2008: Midwifery Competency Standards August 2008:

In simple terms you can continue to practice as an independent/private practice midwife and the women you are looking after will pay for your services as per normal and will not be able to claim a Medicare rebate. As per normal you are advised to keep exemplary notes about the care you have provided and audit your practice and outcomes, so when it is time in two years to apply for Homebirth insurance midwives will have the data to prove that homebirth has good outcomes and is cost effective.
Registration standard for Eligibility: to claim MBS and PBS you will need to be an ‘eligible’ midwife, this means three years experience in the continuum of midwifery care. Completion of further studies relating to pharmaceutical and diagnostic investigations and 20 hours of continuing professional development per year.

National health (Collaborative arrangements for midwives) Determination 2010 – National Health Act 1953 – this document outlines the collaborative arrangements for midwives – basically this document states that midwives have to collaborate (although we already do this and is part of our competency standards) – consultation between the midwife and an obstetric specified medical practitioner, referral of women to a specified midwife, or the midwife is employed or engaged by 1 or more obstetric practitioners or an ‘entity’ that employs obstetricians. The Arrangement – midwife’s written record..... this actually means that you have to enter into a written arrangement that both parties agree to about the care of the woman.....strangely enough there is no provision in this document for what the woman may want here...because if the woman chooses something outside the sphere of the realms of normal the midwife will not be able to continue the care because she will probably not have the support of the obstetrician therefore will not be collaborating and the woman is left stranded...... now what do we do...and herein lies the problem........ with having the medical model trying to control midwives.

At this point in time there is nothing that we can do about this Determination..... the horse has bolted......(a determination is allowed or disallowed) nothing will go forward until after the election.....My fear is that with a Liberal government we will go backwards, there is a slim chance with the labour government that we may be able to amend this document however the Greens are showing more positive support for our plight with this unworkable document.... As a midwife I want to be able to offer women the choice of birthing at home without having to have an obstetrician sign off my care..... I am a professional and know my boundaries, I work within my codes.

I see the way forward as lobbying the government to change this determination by having a strategy of safe clinical care, auditing homebirth and outcomes, peer review and supervision process and risk management strategies...without having to have my care signed off by a Dr...... not to mention the cost effectiveness of midwifery led care as opposed to hospital base care. We need to lobby the government find out who you local MP is and send them an email or letter:

“Hi, I am ………………….., my address is ………………and I live in (your electorate’s name). I would like to let you know that I am concerned with the recent determination passed by the ALP government - the National Health (Collaborative arrangements for midwives) Determination 2010. Midwives already collaborate with medical colleagues but I don’t want them to have to enter a “collaborative arrangement” or any kind of signed agreement with a doctor for the purpose of getting Medicare. I also want all maternity care policies to have the right to informed choice (right of refusal) written in to them. I want a long term solution so that women always have an ability to access homebirth care and I want national visiting access to public hospitals for all eligible midwives.”

It is time to be politically your local MP and find out what their position is!

Tuesday, August 3, 2010

Do you have to believe in God to lead the country?

I was outraged the other morning to hear that Archbishop Barry Hickey is questioning whether Julia Gillard should lead the country because she is an atheist……. Well two things came to mind for me…would he have the same question if the opposition leader was not a so called devout Catholic and second many people turned to atheism when they discovered there so called spiritual leader “priest’ was a child paedophile or an abuser of some sort…….I think that the Archbishop should stick to religion and cleaning up his own back yard before criticising Julia Gillard’s belief’s and the church should keep out of politics…… The Catholic Church is renowned for keeping women as second class citizens…….... and also look at what the 'so called good priests and nuns' have done in the past in relation to child and sexual abuse...not sure that their belief in God made them good people......

‘God’ it’s hard to be a successful woman in a man’s world, Julia Gillard has good leadership qualities. Who is anyone else to judge what sort of person she is because she announces she is an atheist… shallow are people..... the qualities I see in Julia Gillard is that she is law abiding, conscientious, kind and considerate... intelligent articulate etc etc etc....

We need to be looking at policy not gender or belief in God......

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