Re: Patient autonomy and IGT

[Guest guest]

 You hit it for me.  I find the health care world to be paternalistic, condescending, patronizing and 'overly concerned with protecting me from myself' and I hate that I am not considered intelligent enough to know my own body and how it works! I teach moms what they should have known all along! This is her body, she has a right to know how it works, what may or may not be expected, etc.  Knowledge is power in it's own right and I do not hold back knowledge because I find it limits her power.  I have never ever had a mom angry with me for telling her the truth.  Relieved, yes, sad sure, but angry to know why and how and what is going on with her body? No.

Pam

 

I feel this topic begs a discussion regarding numerous factors of medical ethics, including patient autonomy, beneficence, and paternalism.

Definition: Autonomy is the " personal rule of the self that is free from both controlling interferences by others and from personal limitations that prevent meaningful choice. "

The promotion of autonomy also serves the concept of self determination.

Definition: Beneficence is action that is done for the benefit of others. Beneficent actions can be taken to help prevent or remove harms or to simply improve the situation of others.

There is very marginal room for the use of paternalism with fully functioning, healthy, cognizant mothers. There are times when I work with a patient who is less than fully functioning or autonomous meaning they may have compromised intellectual impairments etc. and in that regard I am working with their extended family support system and other professionals to develop a feasible plan. The concept of appropriate use of paternalism in healthcare is more often associated with end of life issues and people who are cognitively effected.

It's very unclear to me how the deliberate withholding of information is considered appropriate in circumstances where it is highly evident that the person whom we are serving as an IBCLC has an evident condition that is likely to effect their circumstances.

To make the discussion more clear, I'm limiting the circumstances to women who have the most marked, evident cases of hypoplasia. No, I don't have a crystal ball but I would bet my house that in these cases, with what I see, (or don't see, glandular making tissue) those women are not going to have full supply.

There are cases that fall upon other points of the spectrum that I struggle with....those are tougher.

-- Pam MazzellaDiBosco, IBCLC, RLCBirthing & Beyond, Inc.Labor Support and Lactation Consultant Services

[Guest guest]

Great discussion. I too err on the side of disclosure -- sometimes delaying

disclosure until we have conquered more pressing problems first. I find the

best thing mothers need to hear is that they WILL be able to breastfeed even if

it isn't 100%. All too often there is the message that they have to do it

perfectly. I've never met a woman with severe hypoplasia that couldn't make

SOME milk. I start the focus on the fact that there is always some milk in the

glass and love in the heart and then go from their to see what is possible for

the mom to do to fill the cup up more. Looking at how empty the glass is never

works.

sburgernutr@...