Issues of CONSENT! When is a consent valid?

"THE lesbian mothers of IVF twin girls have lost a legal bid to sue their doctor for the cost of raising one of the toddlers."

Issues surrounding consent are always interesting. As you are aware there are many forms of consent, verbal, implied and written. Off course we expect that clients are informed about the procedure therefore have "informed" consent. However the notion of informed" is open to interpretation.
The above case was reported in the Sun Herald today:
http://www.news.com.au/heraldsun/story/0,21985,24070929-661,00.html.
A lesbian couple lost their case against an obstetrician when he implanted two embryos instead of one. They also complained of loss of love within their relationship due to the increase in family due to having two babies instead of one. Now we all do know that the chances of multiply pregnancies are greater in IVF when you implant more than one egg - it would be interesting to know if this couple were aware of that. However it was stated that

the birth mother only told him she wanted one embryo minutes before she was sedated, after previously signing a form consenting for up to two embryos to be implanted.

Does this mean that the obstetrician should have postponed the procedure until he was sure what his client wanted? or that the written consent was more valid than the spoken word?

The couple said it was Dr Armellin's responsibility to ensure his patients wishes were carried out during the operation

The case, before Justice Annabelle Bennett, sparked nationwide condemnation of the women in the media.
The mothers issued a statement during the civil proceedings arguing the case had nothing to do with their feelings towards their daughters, but with Dr Armellin's failure to comply with their wishes....

The ACT Supreme Court today ruled in favour of Dr Armellin, and ordered the couple, who live in Melbourne, to pay his legal costs

I think this case involved several issues: that is, it was blurred due to it being a lesbian couple, and the perception that the couple were suing because they were unhappy about the second baby. The real issue here for me was of CONSENT, the woman changed her mind at the last minute and was ignored, she said "I only want one egg inserted" the rest is a red hearing!
It will be interesting to read the full judgement, what do you think?

Audrey - Is our Health System failing us?

Audrey is my sister-in-law, my husband’s sister. Audrey looked after our house and pets whilst we were on holidays. Unfortunately 10 days before we were due home, Audrey had a serious car accident as she was leaving our house for a day out. It was a case of car verses bus, needless to say the bus won. Audrey sustained serious injuries which included a compound facture of her left ankle, actually shattered ankle, and a dislocated and fractured left wrist together with multiple bruising. She was treated in a trauma unit in a major hospital. We were notified of her accident as well as her other siblings whilst in the UK. It is very difficult when you are overseas trying to obtain information about a loved one in such a condition. However after several days of concern, Audrey was recovering, she is lucky to be alive.


Audrey won’t mind me saying she is 72 years old; however she does object when I call her old, so I won’t say she is old. I asked Audrey to smile for the photo as I was going to put it on the blog, and I can not have a sad sack on. However you can imagine this is very distressing to anyone let alone a 72yr old who really has not been sick and is in generally good health and self sufficient. This sort of accident would rock you to your boots.
Audrey was told that she would have months of rehabilitation and would not be able to walk for at least 3mths. This strong self sufficient woman has now been told that she will be staying in hospital and relying on the system until she is well. This is a lot to take in. So now what do we do, we move her from the trauma unit to a regional hospital, I hear you saying what’s wrong with that? Ok you discuss it first and then make a plan and notify the family and then move. No this is not what happened to Audrey, someone came into the room packed up her things, put her on a stretcher and transferred her, just like that. Audrey arrived at the regional hospital traumatised, upset, crying and nervous. The staff were wonderful, reassured her, comforted her and called her daughters who were very upset to see their mother so upset and in pain.
Was this necessary? What adverse effects will this have on Audrey’s recovery?
Audrey settles, her family are about 20 mins away and have organised a roster system to provide constant support for their mother. She begins to recover much quicker and feels that her support network is in place.
Then several days later she is told she is moving and is moved that afternoon, very much the same way as before, no warning to a hospital that is now 45 mins away from her family and they can only visit in the afternoon. Audrey’s mood drops; she feels isolated, lonely, away from her family and shares a room with three other women whose needs are greater than hers. When she rings the bell it may take the staff 15mins before they answer, that’s enough time to wet yourself especially when you are 72. Goodness I have problems when I need to go without having to hang on for 15 mins and the rest it would take to get the bed pan etc. She feels she is a bother to the staff; she worries about the other patients in the room when they ring the bell and it takes a long time to respond.
Audrey now wants to go home, however unable to care for herself she will be depending on her daughters to help her. Her daughters are more than willing to help, but there is a danger about going home to early.
I am not criticising the staff because they take so long to answer the bell, the criticism is directed towards the government because they are not addressing the issue of workforce shortages that is not enough nursing staff.
Nursing and Midwifery shortages are growing every day, we are hugely understaffed and over worked, and nursing standards are reflecting this because nurses do not have the time to provide quality care as they have too much to do.
Audrey is very aware that the health system is failing her and the nurses of this state, it needs a massive injection of funds and staff.
Patients like Audrey understand that there are staff shortages, but there is no excuse for rudeness and bad nursing.
Take the time to talk to your patients ask why are they upset, don’t just leave them crying or say “you have a broken arm it is meant to be painful” empathy and compassion go a long way. It is all in how you talk to patients, kindly, respectfully and with empathy.
Nursing and Midwifery needs passion, you need to enjoy your work otherwise it reflects in the care that your give your patients / clients.
Smile and the world smiles with you, if you do not like your job then do not do it, find what your passion is and do it, then everyone is happy.

Watford, Hemel Hempstead, London, Surrey:

The Finale

We are on the downward spiral of the holidays; 6 days left for the South of England split between Surrey (Cobham), Watford, Hemel Hempstead & London.
We took a leisurely drive from Bridlington, through Hull, over the Humber Bridge to Lincoln. Stopped at the Lincoln Castle, absorbed some history lit a candle in the Lincoln Cathedral and had a late lunch at the local pub. Then it was on the road again heading for Luton - we were going to call in on a friend Laura and her family. Laura and I did our midwifery together, at Hertfordshire. Laura works as an independent Midwife and is also a supervisor of midwifery. It was great to see her again; it was like old times except now she has three lovely boys instead of just one. We had a great afternoon tea now it was time to brave the traffic on the A1 to Surrey.

How could I forget the traffic on the M25, nothing much changes, congestion galore, needless to say took us several hours to get to Cobham.

It was like going home, visiting Watford & Hemel Hempstead. After all I had spent 6 years working and living there. I visited my old hospital Watford General, nothing seemed to changed, it just looked busier.



Helena - Community & Homebirth mentor, Mary - Labour & Birth suite mentor: both tremendous midwives, thank you.

We had a great evening in Hemel Hempstead with my old crew from Watford, the mad midwives. It was a tremendous evening catching up with friends who were also mentors, supervisors, peers and respected colleagues. It is interesting when you get a group of midwives together how difficult it is not to talk shop, the other interesting point is no matter where in the world you work we all face the same issues, staff shortages, medicalisation of childbirth, poor case management, empowering women, negligence, bullying and over work. This could serve as a reminder that the grass is not always greener on the other side. Happy midwifery, keep on being passionate.


London is just fantastic, I love the hustle and bustle and miss going to Leicester Square & Covent Garden for shows & meals. I enjoyed the 2 days in London immensely.

We went to see The Lion King, it was just brilliant. I would of like to see several more shows however time did not allow this.

The weather was not too kind to us, it was raining, windy and cold on and off for the 2 days we spent in London. I guess that is a reminder of how unpredictable the English summer is. Oh I almost forgot how if feels to be a sardine when travelling on the tube how could you forget.
The shopping is just out of this world you are spoiled for choice – there is a down side to all this, it is so expensive and crowed you have to queue for everything. The atmosphere in the city was buzzing. Harrods is arguably the most exclusive retail store, five floors of just exquisite shopping – I was tempted with a pair of Gucci shoes on sale at £185.00 however I had already purchased a few pairs elsewhere and had to think about luggage. There was also a Christian Dior handbag @ £7,500.00 - I could not justify this to myself or my husband so alas did not buy it. We did buy all the grandchildren and I Harrods Bears, and Ian got some golf balls and a hand towel. We bought our lunch from the Harrods deli section and had it in Hyde Park.

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Whilst we have been travelling we have used the city tours the - double Decker buses, they are well worth it as you get to see everything and you are able to jump on and off at any point, its not a bad way to see the city and it is valid for 24hrs.
Its time to go home the holiday is coming to a close; we have had a fantastic time its now time to squash all the shopping into our suitcases and make the long journey home. A flight I am not looking forward to. Ciao till next time.

Yorkshire land of the White rose

York City & York Cathedral

The York Castle:

Yorkshire Dales:

Yorkshire – Castleford – Leeds – Scarborough – Bridlington – York – Whitby – Skirlington markets – The Hornsea Mere –Freeport shopping Centre - North Yorkshire moors – Thornton–Le-Dale The hole of Horcum- – Goathland – Aidensfield – Rosedale Abbey - Lastingham– Pickering (poppies) – Hunmanby – Hull

Bempton

Yorkshire is a really beautiful area, this trip we have managed to see a vast majority of it, you could say we have been up and down the dales.

Ian’s family in the UK: – Beatrice, Norma, Audrey (Australia) Jim and Liz,
their ages range from 75 to 58. They have all been wonderful, warm, loving and inviting. The hardest thing is to say goodbye. It has been good for Kirsten to learn about her family history meeting them all, and to see Yorkshire and England.


Living in Scarborough is Beatrice, the eldest sister with 2 daughters Sharon (Aust) and Bronwyn married to Chaz. Beat has 6 grandchildren and 1 great grandchild – I would describe Beatie as kind-hearted, gentle conservative and a traditionalist wanting nothing more than to have a quiet life and her family around her.
Bronwyn and Chaz also live in Scarborough; they live in a flat over looking Scarborough absolutely wonderful, their home is warm and inviting however you do have to climb 70 stairs (4 flights). Bronnie is very much the quirky, alternative artistic type, gifted in whatever she turns her hand to. Chaz is also artistic with the camera and he runs a stall in the local market as well as an Internet business.


Norma and Harry live in Castleford and are celebrating 52 years of marriage; they have 2 sons and 1 grandchild. Norma is the most outgoing of the sisters; she is exuberant, energetic, boisterous and loveable, however 2 hip replacements have slowed her down. She is a great driver despite Harry driving her nuts in the car. Harry has a wicked wit and is as sharp as a tack, nothing passes him, you could never get the better of him; he is a mind of information. Want to know anything just ask Harry.

Liz & Jo

Liz and Brian live in Bridlington – Brian works in Saudi I never got to meet him as he was away at work, they have 8 children – yes 8, all I can say is thank God they are all grown up. Liz is delightful, quiet, unassuming and thoughtful. We met her daughter Linda who is sociable, friendly, open & loud and a fantastic cook.
Jo and John, are Ian’s cousin (well Jo is) and they live near Liz & Brian in Bempton, what a fantastic couple warm friendly and welcoming, we had our only UK BBQ at Jo and John’s, great barbie but nothing like our Aussie ones.

The Manor & garden: Poppy the dog: Jim, Bibot, Ian, Kirsten

Jim is the older brother to Liz and Ian and is married to Bibot. They live in Cobham Surrey on a Manor Estate in a quaint cottage. It is a picturesque area. Bibot is a quiet friendly Filipino who is working as a domestic / companion for the Lady of the Mannor. Jim is quite the conservative, Victorian man and he likes a good argument, he would do anything for you if he could. It is good to see that Jim has found his green fingers; he has vegetable garden growing, potatoes, cucumbers and various herbs. Bibot has turned her hand to cooking and has become quite the country chef. They both seem very happy and content here. It has been great to stay with them and enjoy their company.

Whitby a great seaside town.
Thornton-Le-Dale, a beautiful place so quaint and the best fish and chips I've had.
playing in the Poppy fields

Home to Perth 13 July 2008