In the United States, one out of three births are performed by cesarean section (c-section) making it one of the most common surgical procedures. Cesarean section is delivery of the baby by creating incisions in the mother’s abdomen and uterus ("Cesarean Birth", 2021). Many women will agree to have a cesarean section to ensure the likelihood of delivering a healthy baby. However, there are women who refuse cesarean delivery regardless of the obstetrician's recommendations due to worry of postoperative pain, concern of cost, cultural and religious beliefs, and incomprehension of the situation (Desphande & Oxford, 2012).
The doctrine of patient informed refusal presents a dilemma in situations where the fetus’s life is at risk and the pregnant woman refuses to undergo medically indicated cesarean delivery although it assures the well-being of her fetus. Some argue the patient’s informed refusal should be respected and the patient autonomy takes preeminence, however others argue the biomedical ethics beneficence and justice and doing no harm to the viable fetus can justifiably overrule the informed refusal of surgery (Desphande & Oxford, 2012).
As discussed in our MSBS seminar class, language and cultural differences can lead to difficulties in communication. A report revealed, in the United States 81% of the women who turned down cesarean delivery were black, Hispanic or Asian; 44% were single, and 24% did not speak English as their first language, and 100% were treated in a teaching-hospital clinic or were receiving public assistance (Desphande & Oxford, 2012). To better navigate this dilemma, obstetricians and the clinical team ought to take the time to understand the reason and motivation behind the patient’s refusal and ensure the patient understands the situation while preserving the trust of the patient-physician relationship. Obstetricians are ought to empathetically encourage the patient to agree to cesarean birth if the risk of morbidity or mortality to the fetus is high. As Dr. Campisi mentioned, it is a disservice to know only one language when pursuing the medical field. As aspiring healthcare providers, we ought to pursue a second language to better understand and serve our patients.
References
Cesarean Birth. (2021). Retrieved 30 November 2021, from https://www.acog.org/womens-health/faqs/cesarean-birth
Deshpande, N. A., & Oxford, C. M. (2012). Management of pregnant patients who refuse medically indicated cesarean delivery. Reviews in obstetrics & gynecology, 5(3-4), e144–e150.
This is an awesome point, I think that consent regarding c-sections is something that needs to be discussed more often. The statistics of misconception between cultures is a scary fact.
ReplyDeleteRegarding your last point on the 24% of patients that did not speak English, I think that healthcare workers could do a better job of attempting to understand these patients' needs or learning a second language.
In hospitals, there have been developments of language translators. A system has been set up where you can sign in with the language and it will match you with a translator that you can see on an i-pad. This was developed so the patients feel like they have a personal connection with the translator and the nurse assisting them. One study found that only 69% of the time, the nurses offer language assistance to the patient. I have seen this where I work, that healthcare workers find it ‘easier’ to understand the patient through hand gestures or nods. Not only is this disrespectful to the patient, but it puts them at risk and hinders his/her care.
Healthcare professionals should be learning a second language or attempting to provide resources to understand non-english speakers. This would prevent the misconceptions between patient and caregiver, hopefully reducing the amount of procedures done without consent.
Lopez-Bushnell, F. K. (2020). Increasing Communication with Healthcare Providers for Patients with Limited English Proficiency Through Interpreter Language Services Education. MEDSURG Nursing, 29(2), 89–95.