“Healthcare Administration During Childbirth”
“Healthcare Administration During Childbirth”
While healthcare in an evolving situation (e.g., an emergency, childbirth, dealing with an unknown issue) can require a nuanced perspective, making decisions to violate someone’s rights is an incredibly serious matter. In research and in clinical practice, there are ethical codes of conduct that practitioners must follow to ensure that someone in their care who is vulnerable is protected (see the attached articles).
Despite this, there are instances where these ethical codes of conduct are violated. This week, we read about several such instances where women’s right to autonomy (respect for persons), beneficence, nonmaleficence, and justice were violated. These powerful and disturbing accounts represent a poorly understood aspect of our obstetric system where women in (or about to begin) childbirth are left powerless compared to their physicians and the authority they can command.
While we can (and must) debate why physicians engage in such blatant disregard of their patients wishes when their patient is otherwise able to make decisions and consent to procedures, I want to focus on the role that healthcare administrators can play in protecting those are in the process of childbirth and ensure that their wishes are respected.
As well educated as physicians are and while they should behave in an ethical matter, the reality is that physicians cannot be expected to be experts in bioethics or healthcare policies (unless they have received education and training in such fields). Physicians are trained to make medical decisions and, when two lives hang in the balance, the weigh various options and provide what they believe to be the best option to their patient. Under pressure, it is only reasonable to anticipate that physicians will focus on those areas where they are confident that their clinical skills will lead to a positive health outcome (in the case of childbirth, a healthy mother and baby). Where hospital administrators can step in is to provide training to clinicians to ensure that they are aware of all aspects of care decisions their patients may make. Importantly, clinicians must be reminded regularly by hospital administrators that ethical principles must be respected whenever/wherever possible and patients cannot be coerced into decisions.
Healthcare administrators must also advocate for patient needs and patient rights, even if that puts them in conflict with the clinical opinions of physicians. As uncomfortable as that may be, I would argue that healthcare administrators have a duty to ensuring that patients are being respected regardless of how we (or the clinician) feel about a given decision. In my view, this naturally extends to advocating for and ensuring opportunities to redress mistakes that are made. Healthcare administrators should lead the charge for improving laws that allow for legal recourse in the event they are harmed by a clinical decision that they were not given a reasonable opportunity to consent to or when they were otherwise misinformed.
What do you think? Is it reasonable for a healthcare administrator to challenge the clinical judgement of a practitioner? How would you address conflicts that would inevitably arise?
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