Hi Joy
It is also inappropriate to practice in this way here in the antipodes.  That said, it is common for such consent to be sought by Maternal Child Health Nurses in Australia and failure to provide that consent can be a contributing factor in leading a mandatory reporter to report a family to the Department of Community Services (child protection agency).
I suspect one of the reasons this clause persists in the IBLCE Code has something to do with the IBLCE being incorporated or registered in the USA and this being a requirement of the body that authorises the IBLCE to credential IBCLCs.  I guess it could be something like IBCLCs only being credentialled to practice under the supervision of a medical doctor ...  And I also suspect that body rarely gives a second thought to whether or not members outside the USA do or do not practice in this way.  I am sure that a current board member could clarify.  Perhaps you might email the office in the US.  I have met most of the staff and they are really keen to clarify this sort of stuff.
cheers
Nina Berry
Australia


On 12/12/2011, at 1:56 AM, Joy Noel-Weiss wrote:

> Dear Colleagues
> 
> 
> 
> Marianne Vanderveen-Kolkena wrote to point out issues she finds with the CoP
> clause requiring a woman's consent allowing LCs to communicate with a
> primary care provider - assumed to be a physician.  I agree with Marianne's
> main position on this matter.  
> 
> 
> 
> For many years, I had read this clause in the original Code of Ethics to
> mean that IBCLCs cannot speak to a woman's other caregivers without express
> written permission.  I like that concept - a woman has the right to go to
> whom she wishes and to share her information as she wishes.  It protected a
> woman's rights.  
> 
> 
> 
> Imagine my shock when the true meaning was explained to me - meet the woman
> at the door and get that consent or else DO NOT treat. WOW !!
> 
> 
> 
> My first problem with this clause is the disrespect for autonomy and a
> woman's right to make choices.  As a life-long patient, I do not give my
> consent easily, and I try to never give a blanket consent.  
> 
> 
> 
> My next problem with this clause is the assumption about who "owns" the baby
> and mother.  I, as the mother, have care and control over my child.  I, as a
> patient and the mother of a patient, am free to change caregivers and no one
> has a right to my baby's information except me and anyone I designate.  I am
> free to consult with someone away from my primary caregiver.
> 
> 
> 
> My final point is about what happens when a woman refuses such consent (and
> I would refuse such consent, since, as a patient, I do not see the physician
> as the boss of me with complete access to my information and control over my
> decisions).  It would mean that I cannot get services.
> 
> 
> 
> Why should two health professionals discuss me in the third person?  Am I
> not free to get all information I choose to get and make my own choices?
> 
> 
> 
> Some IBCLCs I have spoken with consider it a good clause because physicians
> get educated.  I believe their education should come from other places, not
> from case studies of their patients.
> 
> 
> 
> Others I have spoken with see it as necessary to ensure one person knows all
> there is to know about the mother and baby to ensure the right care is
> decided.  It is the responsibility of each caregiver to develop a
> therapeutic relationship, to get a complete history, and to be aware of any
> changes a client/patient made since last seen.
> 
> 
> 
> It seems a clause that was built to provide seamless care has become
> outdated in a world that upholds patients' rights and is (I hope)
> recognizing that physicians and other health care professionals do not own
> the mother and baby.  As health care providers, we are responsible for the
> teaching we do, and the women we see have authority for choices they make.
> 
> 
> 
> Joy Noel-Weiss RN IBCLC
> 
> 
> 
> 
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