Informed consent

[CharonY]

I am not entirely sure whether this is a suitable start for a conversation, but I cam across this report from a Canadian health (in the province of Saskatchewan). Report, News article 1 News Article 2

It details the experience of a number of aboriginal women who were coerced into tubal ligation, effectively a sterilization technique. In at least one case they were misinformed and the procedure was characterized as reversible. Now, there has been a long and ugly history of forced sterilization of aboriginals. But what I want to highlight is how important the "informed" part of informed consent is. I will admit that I am a tad outraged, especially as I am involved in medical research and have to undergo ethics review (though at times annoying) and training specifically to ensure that participants know precisely what they are in for. That medical professionals still can misinform their patients towards unnecessary, irreversible procedures based on what is seemingly a racist attitude is just unbelievable.

 

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“The ideology that justified historical coerced sterilization continues to shape state and medical interventions in the reproductive lives of women, (especially) marginalized, racialized and Indigenous women,  pressuring them to get sterilized for their own good, to save them and society from having to care for additional children,” Stote stated.

I will add that only few women have come forward so that it may be isolated incidences. However, considering the population distribution from what I can see, people living there have a high chance of getting in contact with said health providers.

Edited July 28, 2017 by CharonY

[imatfaal]

Firstly - the inhumanity that we visit on our fellow man is quite frightful and shaming. 

From a perspective grounded in English and Welsh Law (and I expect Canadian law will be broadly similar) I would claim that not only is the consent claimed by the hospitals in this case not informed consent but that it was obtained under duress and in circumstances under which true consent cannot be given due to lack of capacity.  I am not sure that this is a good example of informed consent or the lack of it due to the catalogue of malfeasance and malpractice - bullying a woman just post partum like that is criminal.  Lying about outcomes, or reversibility is so wrong that it is no longer an issue of the niceties of medical ethics it is a criminal act

On your point: consent is not consent unless it is informed - but the important caveat is the information given will, by its very nature, be less than complete from a scientific or medical perspective.  It is the level, detail, and complexity of the information given to the patient which is crucial - and to an extent arbitrary; and whilst something like this is open to a subjective approach it is also open to very wrongful manipulation.  It is why you are sent on courses - it is a difficult and recondite subject with the most important subject matter.  I I took one and audited one other medical ethics courses whilst at law school and touched on it in a course on governance of genetics -  my brother taught medical ethics as a physician to medical students; we had some quite royal arguments on the intersection of the two approaches. 

I must admit I thought male authorities quest for control over female bodies was a phenomenon of the land to the south of the border - fertility rights are the next big battleground and I thought that was a fight we won in the 60s.  But lets not go off-topic. 

[CharonY]

11 minutes ago, imatfaal said:

my brother taught medical ethics as a physician to medical students; we had some quite royal arguments on the intersection of the two approaches. 

I am curious, do you recall the basis for the arguments you had? I was quite surprised as I have collaborations North and South of the border and all medical professionals were quite good in following the guidelines that we put forth. On reflection, the reason may have been specifically because it was a research project and people may take more care than they would do in their day-to-day business.

[imatfaal]

That the individual medical practitioner should, even with suitable training, sometimes would be in a position of seeker of consent, provider of information, confidante/advisor, and executor of the procedure;  it seemed to me that a division of powers was necessary.  Even with an enlightened and purely honourable Doctor the possibility of well-meaning paternalism is difficult to avoid; any latent or subconscious foibles, fears, and preconceptions of the physician would be imparted to the patient even if without knowledge or intent; and that a more robust, external and non-arbitrary system would, importantly shield Doctors from accusations of impartiality and patients from uncertainty / lack of trust in the process they were within. 

[imatfaal]

FYG - Came across this today https://fernwoodpublishing.ca/book/an-act-of-genocide 

Being referenced next to reports from Saskatoon today - it is worrying when a historical narrative reporting acts from over a hundred years ago is informative and paralleled by a modern investigation

[CharonY]

13 hours ago, imatfaal said:

That the individual medical practitioner should, even with suitable training, sometimes would be in a position of seeker of consent, provider of information, confidante/advisor, and executor of the procedure;  it seemed to me that a division of powers was necessary.  Even with an enlightened and purely honourable Doctor the possibility of well-meaning paternalism is difficult to avoid; any latent or subconscious foibles, fears, and preconceptions of the physician would be imparted to the patient even if without knowledge or intent; and that a more robust, external and non-arbitrary system would, importantly shield Doctors from accusations of impartiality and patients from uncertainty / lack of trust in the process they were within. 

 

That is an interesting point. One assumption is of course that the medical professional has the best interest of the patient in mind. But even if it is true, personal bias can be an issue. Of course having an external negotiator of sorts would be a logistical nightmare. Also it is almost impossible to find a truly neutral party. The only recourse that a patient has is currently getting a second opinion. But in many cases (including emergencies) that is also not an option.

 

7 hours ago, imatfaal said:

FYG - Came across this today https://fernwoodpublishing.ca/book/an-act-of-genocide 

Being referenced next to reports from Saskatoon today - it is worrying when a historical narrative reporting acts from over a hundred years ago is informative and paralleled by a modern investigation

That was the background to the whole thing. In public discourse it appears that people have forgotten that this practice has been going for a long a time and have actually only recently been ended for certain groups. While we are in Canada, the Sexual Sterilization Act of Alberta was only struck down in the 70s. Only this year in the EU it was found to be unlawful to have laws forcing transgender people to be sterilized to have their gender change accepted.

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The Court found that requesting proof for “having undergone a sterilising operation or medical treatment resulting in a very high probability of infertility, amounts to a breach by the respondent State of its positive obligation to guarantee the right […] to respect for […] private life.” Thus, states cannot demand from a person seeking legal gender recognition to undergo any medical treatment that would most likely result in sterility.

 

[MigL]

Don't worry.
All those women's rights were violated.

Our Prime Minister will issue each one of them an apology and $10.5 mill in compensation.

Oh, wait a minute. They're not terrorists.
Forget that !

[CharonY]

I do not think that the snark is warranted. 

[MigL]

It wasn't directed at anyone here, or violated women, but rather my Prime Minister.

I will wait and see what ( if any ) compensation these women receive.

[CharonY]

There is no comparison. First of all so far only one woman is attempting a lawsuit, the rest chose to remain unnamed and it is still unclear whether there will a class-action lawsuit. However, the report may add fuel to that matter. Second, the lawsuit cannot be targeted at the government, it will be against the health provider. I assume that their budget is more limited in terms of what a lawsuit might claim. Third, the Khadr lawsuit (which is off-topic) was based on violation of rights by the government as judged by the Supreme Court (I believe essentially when Canadian intelligence officers engaged in interrogation, but I would have to read up on the supreme court decision). As such the only decision your government could have made was fighting a losing legal battle. Fourth, even if there is circumstantial evidence, Khadr's  trial and conviction is considered to be questionable by legal experts. So sorry, except it happening in Canada I do not see a lot of parallels to draw here.

[MigL]

And I see a lot of parallels, CharonY.

One woman, and O Kahder was only one person who launched his lawsuit.
There are no independent health providers in Canada. While health care is run by the provinces, oversight and universality is the responsibility of the federal government.
so if you can make the argument that the Canadian government didn't do enough to protect the rights of O Kahder when he was captured, convicted and imprisoned by Americans, you can certainly make the case that they didn't do enough to protect the rights of these women.
Legal experts in the US certainly aren't questioning the conviction, and the family of the slain medic was awarded a wrongful death conviction against O Kahder, which the Canadian government has seen fit to disregard, and hide O Kahder's $ 10.5mil, so it cannot be touched.

I guess protecting the rights of aboriginal women isn't as 'glamorous' as protecting the rights of a terrorist.

But you're right, this is off topic. I won't bring it up again.
But I'd rather my government treated our aboriginals better.

[CharonY]

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But I'd rather my government treated our aboriginals better.

I agree with that. But a few issues and I will let the thing rest. Most hospitals in Canada are not government owned, but run by non-profits. The financing is run by the (provincial) government as far as I understand. Moreover, in a malpractice lawsuit usually the medical provider him/herself is getting sued. This is why all physicians are covered by the medical protective association (which is basically a non-profit liability insurance). So in order to sue the government one would likely have to prove that somehow the practice is connected to something the government has issued, like for instance the Sexual Sterilization Act of Alberta. With regard to the tribunals, I would urge you to read up on the proceedings, even without the torture, there were flawed in many ways, including witnesses changing statements as to who may have thrown the fatal grenade. Either way, the proceedings have been tainted from the get go and it is unclear how it would have ended if it had ended in criminal court. Assuming that it is a sure thing is, at best, a gross distortion of the happenings.

 

But that being said, it should not be an either or situation. Human rights have to upheld for all citizens.

[imatfaal]

5 hours ago, CharonY said:

But that being said, it should not be an either or situation. Human rights have to upheld for all citizens.

 

"Human rights have to upheld for all citizens."  Human rights have to be upheld for everyone, citizens or not - they spring from the belief in the importance of our shared humanity not from our nationality. 

[CharonY]

4 hours ago, imatfaal said:

"Human rights have to upheld for all citizens."  Human rights have to be upheld for everyone, citizens or not - they spring from the belief in the importance of our shared humanity not from our nationality. 

You are correct, of course. I mistyped.