Cooper, Mary Glenn
(2012)
“WE’RE HAVING THIS BABY TONIGHT!”
INFORMED CONSENT AND MEDICAL DECISIONMAKING
REGARDING OXYTOCIN AUGMENTATION.
Master's Thesis, University of Pittsburgh.
(Unpublished)
Abstract
The medical indications for oxytocin augmentation in childbirth are inconsistent, the benefits of the intervention are often ambiguous and value-dependent, and there are significant risks, which are still being evaluated and elucidated. Providers tend to make the decision to augment labor without inquiring into patient preference. Rather providers declare their intent to augment with little or no discussion with patients, not even regarding risks, benefits and alternatives. In this thesis I argue that augmenting with oxytocin, in the absence of informed consent, violates norms of ethical clinical practice: seeking consent in cases of significant risk or ambiguous indications, avoidance of the generalization of medical expertise and bias in medical decisionmaking, and incorporation of patient preferences in shared decisionmaking. The introduction examines the goals and requirements of informed consent in general and as they relate to oxytocin augmentation. Chapter 1 argues that determination of medical need for oxytocin augmentation is complex and controversial. Chapter 2 explores a distinct hierarchy of stakeholders involved in the decision to augment, many of whom have self-interests that should be elucidated with patients when oxytocin is used. Chapter 3 argues, with particular attention to recent feminist work, that informed consent for oxytocin augmentation should be a meaningful process that promotes patient autonomy and well-being, not just an expansion of a range of choices. Using this construction of informed consent as process, it may, at least, be possible to address all three of the violated norms of ethical clinical practice, even those concerned with bias, power structure, and preference. In addition to extensive research of the literature, the material presented here draws from the author’s observations during shadowing, experiences on the labor and delivery ward as a medical student, and from discussions with clinicians, nurses, and other medical students.
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Details
| Item Type: |
University of Pittsburgh ETD
|
| Status: |
Unpublished |
| Creators/Authors: |
|
| ETD Committee: |
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| Date: |
29 May 2012 |
| Date Type: |
Publication |
| Defense Date: |
15 February 2012 |
| Approval Date: |
29 May 2012 |
| Submission Date: |
20 April 2012 |
| Access Restriction: |
No restriction; Release the ETD for access worldwide immediately. |
| Number of Pages: |
77 |
| Institution: |
University of Pittsburgh |
| Schools and Programs: |
Dietrich School of Arts and Sciences > Bioethics |
| Degree: |
MA - Master of Arts |
| Thesis Type: |
Master's Thesis |
| Refereed: |
Yes |
| Uncontrolled Keywords: |
oxytocin augmentation, childbirth, ethics, informed consent, labor |
| Date Deposited: |
29 May 2012 19:37 |
| Last Modified: |
19 Dec 2016 14:38 |
| URI: |
http://d-scholarship.pitt.edu/id/eprint/11914 |
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