Memorandum in Opposition: A. 10809-A
The American College of Obstetricians and Gynecologists (ACOG), District II opposes legislation to dictate and specifically prescribe the informed consent process for primary cesarean section outlined in A. 10809-A. ACOG District II and the obstetricians and gynecologists we represent strongly support educational efforts to ensure women understand their health care options in all situations, and for all procedures. Unfortunately, this legislation interferes with the physician-patient relationship, and we encourage the legislature to reject it.
Obstetricians and gynecologists, like all physicians, are governed by the ethical doctrine of informed consent.1 Ob-gyns, as the providers who build close relationships with women during some of the most important health moments of their lives, fully abide by this doctrine. As trusted women’s health providers, ob-gyns seeks informed consent in order to express respect for the patient as a person, and in particular, a patient’s moral right to bodily integrity, to self-determination regarding sexuality and reproductive capacities, and to support a patient’s freedom to make decisions within caring relationships.2 Informed consent ensures the protection of the patient against unwanted medical treatment and also makes possible the patient’s active involvement in her medical planning and care.3 Informed consent is a process, not a signature on a form and includes a mutual sharing of information over time between the clinician and
the patient to facilitate the patient’s autonomy in the process of making ongoing choices.4 The provision of a primary cesarean section is not an outlier to this doctrine, it is one of many medical procedures provided by ob-gyns that is governed by the physician’s ethical duty to ensure informed consent is received.
The one-size fits all approach of this legislation is unlikely to achieve its intended effects of more informed patients or a reduction in primary cesarean delivery. Boilerplate language delivered to patients regarding risks and benefits of cesarean section does not further patient-centered care. Ob-gyns already take into account each patient’s specific risk factors and health needs in order to create tailored guidance for patients, including at hospital discharge. In order to
optimize the health of women and infants, ACOG recommends that postpartum care become an ongoing process, rather than a single encounter, with services and support tailored to each woman’s individual needs, including counseling and discussion about future pregnancy and delivery plans.5
In addition to our concerns with the intent of the bill, the language used throughout is not consistent with accurate clinical nomenclature in the field of obstetrics and gynecology. This puts physicians in the untenable position of attempting to obtain informed consent while being legislatively mandated to use inaccurate and confusing language. This legislative interference in the practice of medicine is profoundly troubling.
ACOG District II, in partnership with National ACOG, continuously issues guidance to ensure that women receive the highest quality care during their pregnancy and delivery. ACOG, in partnership with the Society for Maternal-Fetal Medicine, has published extensive guidance on safely preventing primary cesarean delivery. 6 Additionally, ACOG’s Committee on Obstetric Practice has created guidance for providers on how to counsel patients seeking cesarean delivery on maternal request.7 Efforts to place additional requirements on the informed consent process for primary cesarean section are misguided. We encourage the legislature to instead work to support New York’s dedicated ob-gyn community and to ensure they have the resources necessary to build strong relationships with the women they serve.
ACOG District II appreciates the Legislature’s continued focus on reproductive health care, and we look forward to finding innovative ways to encourage patients to take an active role in their health care while respecting the sanctity of the physician-patient relationship. ACOG District II urges lawmakers to reject this problematic legislation.
1 American College of Obstetricians and Gynecologists. Informed Consent. Opinion No. 439. ACOG Committee Ethics. Reaffirmed 2015.
5 American College of Obstetricians and Gynecologists. Optimizing Postpartum Care. Opinion No. 733. ACOG Committee on Obstetric Practice. May 2018.
6 American College of Obstetricians and Gynecologists. Safe Prevention of the Primary Cesarean Delivery. Obstetric Care Consensus Number 1. American College of Obstetricians and Gynecologists and the Society of Maternal Fetal Medicine. Reaffirmed 2016.
7 American College of Obstetricians and Gynecologists. Cesarean Delivery on Maternal Request. Opinion No. 559. ACOG Committee on Obstetric Practice.