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Monday
Jun152009

The AMA's "Ungrateful Patient" Resolution: A Cautionary Tale

 

You are leaving work after a busy day. Purse tucked under your arm, you cautiously enter the parking structure and walk to your car. The word around the office is that several women have been beaten and robbed on the way to their car and the police have not been able to identify any suspects. Before leaving, you weighed the risk of walking to the car in the dimly lit parking structure against the uncomfortable feeling of asking someone to help walk you there and decided to take your chances.

Fumbling in your purse to find your keys, you hear footsteps behind you. You walk faster. The sounds of the footsteps behind become more frequent. Facing your fears, you spin around only to see the company’s head of security and a security guard standing behind you with a club. As the security guard grabs your arms and pins them behind your back, you take one last ditched effort to defend yourself by kicking the head of security in the crotch. He doubles over and hollers, causing his partner to panic and flee the scene. The recipient of your kick retreats into the shadows of the parking structure.

Still shaking, you run to your car, lock the doors, dial 9-1-1 on your cell phone and peel out of the parking space. You park right outside the exit to the parking structure and wait for the cops to arrive.

As you tell the police officer the story, your assailant walks out of the parking structure and throws his arm around the officer. As it turns out, the head of security has been having an affair with this police officer for years. Together, they handcuff you and take you to the police station. They openly discuss your behavior in the front seat, complaining about how you were arrogant enough to resist the attack and indignant enough to try to make your assailants look bad by alerting authorities to their behavior. What is with these women lately? they wonder aloud. If they keep this up, there will be no more security guards.

After sitting in a holding cell for a few hours, you are released. You take a cab back to your car, race home, lock the doors and leave a message on your supervisor’s voicemail that you will not be returning to work and try to explain the events of the evening.

You hear a knock on your front door two weeks following your attack. A courier holding a thick envelope asks your name and tells you that you’re being served. You quickly close your door and start reading.

Your former employer is suing you.

It seems you should have been grateful for the security services that they provide. You are being sued for damages caused by your swift, abusive and hostile kick to the head of security’s crotch. The security guard, who witnessed your hostility, has begun to suffer from migraines. Neither employee has been satisfied with their job since you fought back. In addition, the repercussions of the attack, including you quitting without notice, have caused a drop in company productivity and the company believes you should be held financially responsible. You will never work in this state again.

 

***

 

Women want VBAC (vaginal birth after cesarean). They are sick and tired of being bullied into unnecessary cesareans that are scheduled to assuage their doctor’s fear of litigation under the guise of protecting women from potential harm.

If the AMA’s Resolution 710 passes, a woman at Kendall Regional Medical Center in Miami, Florida who tells her doctor that she knows that the hospital’s cesarean rate is 70.3 percent and refuses to schedule an elective primary cesarean for suspected macrosomia unless she can present her with actual evidence that she or her fetus is at risk of injury might find herself facing a different risk—losing her insurance coverage.

By refusing an unnecessary cesarean, induction or intervention, a woman can be coded as non-compliant or hostile if they don’t remain in the good graces of their doctor. According to the resolution, physicians and their office staff experience stress from “ungrateful patients,” which may lead to ill health.

Unnecessary medical procedures also contribute to stress and ill health of patients, no matter how much easier they make life for the doctor performing them.

Regardless of what the American Medical Association says or implies by such resolutions, patient autonomy in maternity care trumps a physician’s need to feel appreciated, obeyed and satisfied with their own career. The right to VBAC and the right to refuse unnecesareans is a civil rights issue. Resolutions like this make it difficult for many women to see the doctors that they want so badly to be able to trust as motivated by anything more than ego and fear.

Resolution 710 might have positive implications for other areas of care, but in a pro-unnecessary intervention maternity care climate, it will be nothing but devastating to pregnant women.

 

But the parking structure attack imagery… wasn’t that a little much?

 

I don’t know. Ask Laura Pemberton.

When Laura Pemberton chose to give birth at home in Florida, a sheriff came to her house. Doctors believed that she was posing a risk to the life of her unborn child by having a vaginal birth after having had a previous c-section. The doctors were in the process of getting a court-order to force her to have a c-section. The sheriff took Ms. Pemberton into custody during active labor, strapped her legs together and forced her to go to a hospital where an emergency hearing was taking place to determine the rights of her fetus. She was “allowed” to represent herself. A lawyer was appointed for the fetus. This woman, who vehemently opposes abortion, nevertheless believed in her right to evaluate medical risks and benefits to herself and her unborn child. She was forced to have the unnecessary surgery and when she later sued for violations of her civil rights, was told fetal rights outweighed hers.

 

Tell the American Medical Association how you would feel about being coded “non-compliant” or “ungrateful “and urge them not to pass the resolution. Click here to find your state’s medical society web site and contact them. The AMA’s web site says that voting is scheduled for Tuesday, June 16, 2009 from 7:00 a.m. to 8:45 a.m.

Edit (June 15, 2009 at 9:00 pm PST): 710 came up in Monday afternoon’s vote and was unanimously defeated. Confirmation has not yet been posted on the AMA’s web site.

 

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Reader Comments (7)

After reading this, I am still speechless. They complain all the time that people have the right to choose, and have the right to make their own life, but now they can forcibly make a woman have a surgery she doesn't want because the 'fetal rights outweighed hers'? I thought fetus' didn't even have rights since they aren't babies? And a vaginal birth is better for the fetus anyway! So their argument is moot to begin with!!

I think the police story at the beginning was perfect. It actually made it seem like this wasn't an issue with pregnant women as much, because now there is a broader scope of fire (if that makes sense).

If this passes, the results in this country will be drastic. No more VBAC? Not that there is a lot of it in this country to begin with, but to take the right away? I have been worried this day would come since they gave me a cesarean. I would do anything for a VBAC. What happens when they take this option away from women because we won't 'acquiest' to our doctor's wishes? How many women have to die from unnecessary surgery and how many babies have to go into a NICU for them to see that this is a mistake?

Why is it that other people can vote what is good for a mother and baby! I bet they are all men that are voting.

June 15, 2009 | Unregistered CommenterKayce

"They complain all the time that people have the right to choose"

Know what makes me nuts? All of the efforts and money spent to explore the ethics of primary maternal request c/s while women struggle everyday to find someone to attend their birth if they've already had a c/s. We can probably all name at least a handful of women we know personally who said they wanted a vaginal or a natural birth at the beginning of their pregnancy, then gave up the fight at some point because it was just too much to deal with.

If the NIH, et. al., want to spend time exploring whether women should have the right to choose a cesarean, they'd better also explore how a woman should have the right to choose to give birth vaginally (since that's what's going to occur whether they are in the presence of medical personnel anyway!). If it can happen in the car on the way to the hospital, a woman had better have the right to let it happen in the hospital without anyone interfering.

June 15, 2009 | Registered CommenterJill

Nice analogy! Very nice article.

June 15, 2009 | Unregistered CommenterDiana

I completely agree Jill!!! It is such hypocrisy and it just makes me crazy!

June 15, 2009 | Unregistered CommenterKayce

I still can't write a coherent response to this. I am shocked, and appalled, and all sorts of of cliches about it. I am very grateful for my care providers - when they treat me as an intelligent person capable of questioning and deciding my own best course of treatment.

June 15, 2009 | Unregistered CommenterTara

I can't believe this whole "non-compliant" patient jazz--What's next? What made this such a priority for AMA? I don't get it.

As for Laura Pemberton story...ugh. Whenever I see it, my blood begins to boil. That's just scary. That's something you would see on a movie or corny TV drama, and say,"Yeah right-that would NEVER happen". Think again.

1984, anyone?

June 15, 2009 | Unregistered Commentermichele

This makes me think of former Australian AMA President Andrew Foote, OB. He weighed in on a controversy a while back in which a lesbian couple sued for being implanted with 2 embryos instead of 1 during IVF treatment. Their side of the argument is that they only wanted 1 baby and sued for the cost of raising the second baby, around half a mil if I remember correctly. Anyway, Dr. Foote was all over this issue, and I think that the word ungrateful was used to describe the parents. He also stated that women should not be able to sue if the baby was healthy. An elected official, John Stanhope, recognized that removing a woman's right to sue for damages based solely on the issue of a "healthy (read live) baby" would remove the right to sue for damages done to the mother. So the AMA on both sides of the globe have been chewing this issue for a while now. What they want is a no-fault system in which they can no longer be sued at all. What they need is transparency and more accountability. What the public needs is a clear separation between medicine and State.

June 15, 2009 | Unregistered CommenterAnon
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