ABSTRACT
A 15-year-old girl is scheduled to undergo an upper lobectomy to debulk metastatic Ewing sarcoma. The anesthesiologist recommended placement of a thoracic epidural catheter to provide postoperative analgesia. The patient did not want a needle to be placed near her spine. She was terrified that the procedure would be painful and that it might paralyze her. Although the anesthesiologist reassured her that sedation and local anesthesia would make the procedure comfortable, she remained vehemently opposed to the epidural procedure. The parents spoke privately to the anesthesiologist and asked for placement of the epidural after she was asleep. They firmly believed that this would provide optimal postoperative analgesia and thus would be in her best interest. Experts discuss the pros and cons of siding with the patient or parents.
Subject(s)
Adolescent Behavior/ethics , Anesthesia, Epidural/ethics , Pain, Postoperative/prevention & control , Parent-Child Relations , Physician-Patient Relations/ethics , Treatment Refusal/ethics , Adolescent , Adolescent Behavior/psychology , Anesthesia, Epidural/methods , Anesthesia, Epidural/psychology , Bone Neoplasms/psychology , Bone Neoplasms/surgery , Female , Humans , Pain, Postoperative/psychology , Parents/psychology , Sarcoma, Ewing/psychology , Sarcoma, Ewing/surgery , Treatment Refusal/psychologyABSTRACT
Women recognise that labour represents a mind-altering event that may affect their ability to make and communicate decisions and choices. For this reason, birth plans and other pre-labour directives can represent a form of Ulysses contract: an attempt to make binding choices before the sometimes overwhelming circumstances of labour. These choices need to be respected during labour, but despite the reduced decisional and communicative capacity of a labouring woman, her choices, when clear, should supersede decisions made before labour.
Subject(s)
Advance Directives , Analgesia, Obstetrical/ethics , Choice Behavior , Informed Consent , Labor Pain/drug therapy , Labor, Obstetric , Mental Competency , Parturition , Personal Autonomy , Vaginal Birth after Cesarean/ethics , Anesthesia, Epidural/ethics , Beneficence , Contracts , Decision Making , Female , Humans , Informed Consent/ethics , Informed Consent/psychology , Labor Pain/psychology , Labor, Obstetric/psychology , Metaphor , Parturition/psychology , PregnancyABSTRACT
No disponible
Subject(s)
Female , Humans , Male , Injections, Spinal/ethics , Injections, Spinal/instrumentation , Injections, Spinal/standards , Anesthesia, Epidural/ethics , Anesthesia, Epidural/methods , Chronic Pain/therapy , Drug-Related Side Effects and Adverse Reactions/complications , Drug Interactions , Codes of Ethics/legislation & jurisprudence , Insurance, Pharmaceutical Services/ethics , Insurance, Pharmaceutical Services/legislation & jurisprudenceABSTRACT
Triplet pregnancies are at an increased risk for perinatal complications. Cesarean delivery is the preferred choice in most cases. In the presented case of a Jehovah's witness the special features of anaesthesiological managements are discussed.
Subject(s)
Anesthesia, Epidural/ethics , Anesthesia, Epidural/methods , Delivery, Obstetric/ethics , Delivery, Obstetric/methods , Jehovah's Witnesses , Triplets , Adult , Female , Humans , Pregnancy , Pregnancy OutcomeABSTRACT
BACKGROUND: Ethicists agree that informed consent is a process rather than just simply the signing of a form. It should provide the patient with needed information and understanding to authorize a procedure. Essential elements of informed consent for women requesting labor epidurals include a description of the procedure, the risks and benefits, and alternative treatments for analgesia including the associated risks and benefits. The purpose of this pilot study was to determine practices and opinions of obstetric anesthesiologists regarding informed consent for parturients. METHODS: Questionnaires were sent to 885 anesthesiologists who were members of the Society of Obstetric Anesthesia and Perinatology based in United States institutions in 2002. RESULTS: Of the 885 questionnaires sent, 448 (51%) were returned with 47% from academic and 47% from private practice institutions. Forty-six percent worked as part of an obstetric anesthesia team; 51% worked in centers where there were >3000 deliveries/year. Sixty-eight percent suggested that "parturients in active labor are able to give informed consent for labor epidural analgesia." Thirteen percent recommend antenatal anesthesia consults for parturients inquiring about labor epidurals and 41% participated in childbirth classes. Responses did not differ significantly between physicians in academic vs. private practice. More obstetric team practices than non-team practices participated in childbirth education (54% vs. 30%, P < 0.0001). CONCLUSION: Despite the painful, stressful circumstances confronted by parturients, many respondents (76% in academic, 64% in private practice) thought that women in active labor are able to give informed consent.
