(Repost) Informed consent: As simple as asking?

This post originally appeared at On The Left.

The experience of a woman who had an IUCD inserted without her knowledge shows that there’s still a long way to go when it comes to informed consent in New Zealand.

The intrauterine contraceptive device was inserted when the woman went to Epsom Day Unit to have an abortion in 2010. She had not consented to having it and it was only in 2013 that she discovered it, after unsuccessful attempts to get pregnant.

An investigation by the Health and Disability Commissioner found the doctor mistakenly “assumed” the woman wanted the contraceptive device after seeing it on a hospital trolley.

There’s a lot of deep, serious stuff you can get into about informed consent – an issue with a dark history in New Zealand. Sandra Coney’s book recounting the Unfortunate Experiment at National Women’s Hospital in Auckland was one of the first “feminist” books I read, and even though I wasn’t old enough to really understand all the issues (certainly not the science) one thing was really, horribly impressed on me: that patients have the right to know what’s happening to them. And they must be allowed to make their own choices. And cis women (and, I’d learn as my feminism developed, trans women, people of colour, people with disabilities, people in every marginalized group and especially people in more than one) were frequently, automatically, denied that choice.

It raises a lot of questions about the assumptions we make (doctors are demigods, patients aren’t rational, science is unbiased) and the systems and structures we have around medical care, which feed in turn into questions about how our society regards certain people (e.g. husbands having the power to commit their wives to mental institutions). Those are big, meaty ideas which could require a lot of soul-searching and discussion.

But in this case – based on nothing more than reading the Stuff article quoted above – it seems that the woman’s trauma could have been entirely avoided just by a surgeon bothering to ask, “Hey, is this IUCD for you, or another patient?”

Add in the fact that Auckland District Health Board initially refused to acknowledge that anything was wrong with depriving someone of the ability to have children for three years, and this seems to be much less about serious ethical considerations about informed consent, and more about sheer arrogance and lack of concern about people’s wellbeing.

So what do we do to change that? In this case it’s good that the Health and Disability Commissioner has taken action to make it very clear that this kind of thing simply cannot happen. Auckland District Health Board has been “recommended” to do a spot review of patient records to make sure this hasn’t happened multiple times. We need to pay close attention to make sure that they actually change the way they do things to stop it happening again.

(I’ve tried to use gender-neutral language where appropriate in this article. Not all people who become pregnant/get abortions/have IUDs are women, and not all women can get pregnant. But I think the medical establishment, like society, still groups all people who are assumed to have uteri and assumed to be able to get pregnant under the heading of “women”, and the second-class status of that group is a contributing factor to this particular case.)

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