Kathy Eng posted on November 4 with some references to ILCA's Standards of
Practice for the IBCLC.
From the ILCA document as cited by Kathy:
#2.3 says "Obtain informed consent from all clients prior to: assessing or
interviewing, reporting relevant information to other health care
professionals, taking photographs for any purpose, seeking publication of
information associated with the consultation."
#3.3.7 "Document and communicate to health care providers as
appropriate: assessment information, suggested interventions, instructions
provided, evaluations of outcomes, modifications of plan of care, follow up
strategies."
And, from the IBLCE code of ethics, #23, again cited by Kathy:
"Require and obtain consent to share clinical concerns and information with
the physician or other primary health care provider before initiating the
consultation."
I'm really embarrassed to say that I had not thought over the implications
of this last point, before the current discussion on the IBLCE Scope of
Practice document. As someone else has pointed out, national law trumps
codes of ethics, and the laws in many countries about sharing information
between health care providers is much stricter and more skewed toward the
patient's right to privacy than to the health care provider's need to know
every last detail, than this point reflects. Only IBLCE seems to feel that
it is appropriate to make 'agreement to share information among caregivers'
a condition for getting the help of an IBCLC at all. ILCA merely lists
'reporting relevant information to other health care professionals' among
the several things one must have the client's informed consent to do. This
is not at all the same, and for my money, ILCA's views on who is in charge
of the client are much more compatible with my own - namely that it is the
client who retains the right to share information, or not, about her own
care. It is also the client who retains the right to follow my advice or
not, and I strive to create a climate in which mothers will not hesitate to
tell me if they have decided to do something other than what I have
suggested, because it is one of my most valuable avenues for learning.
I don't think I would have qualms about discussing the reasons a client did
not want information shared, nor about giving her my opinion if I felt there
were arguable reasons to share it, but I would be very hard pressed to
refuse to do a consultation if she decided to stick with her wish for
confidentiality. Where I live I am compelled by law to report to Child
Protection if I know, or have reason to believe, that a child is being
harmed or is in danger of imminent harm, but that is the only situation in
which a mother's right to confidentiality may be overridden.
My only defense for how I have practiced in ignorance of and in conflict
with the IBLCE code of ethics #23 is that my entire practice takes place
within the framework of my employment as a midwife, wherein I follow the
rules for midwives as well as Norwegian law.
Liz Brooks, if you are reading this, could you comment on the fundamental
differences between IBLCE's code of ethics and the ILCA standard of
practice?
Rachel Myr
Kristiansand, Norway
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