On 02/11/2006, at 5:06, Pamela Mazzella Di Bosco wrote:
> However, I have no problem with making it obligatory to report to a
> hcp all
> visits.
The problem I have with this is: it is outright illegal to do so here
without the mother's express, informed and non-coerced consent.
Exceptions are only made in situations such as a subpoena, or a major
emergency in which the person is not competent speak for themselves.
An professional code of ethics or scope of practice can't trump
national law. If a mother chooses to withhold consent for a
practitioner to share her medical information with another
practitioner, would the practitioner have a solid basis for refusal
of care? I wouldn't like to try to make a case for that.
I doubt the refusal would happen very often, but when it does happen,
it is entirely the mother's (legal, and in my opinion moral) right to
choose her own level of autonomy, to be informed of any risks
involved, and to still be able to access care.
> I think our scope of practice should be limited to all things
> related to
> lactation. Of course, lots of things relate to lactation, but
> surely not
> assessing vaginal repairs or surgical incision healing or whatever
> other things
> were listed as things they have heard of LCs doing.
Earlier in the conversation someone mentioned enquiring about lochia
and incisions - I would have thought that these are very much related
to lactation? Retained placenta or wound infection can impact on milk
supply. A very painful perineal or C section wound may be causing
problems with sitting and positioning. This doesn't mean that the LC
takes on diagnosis and treatment of problems related to infection or
wound complications, but including these questions in a full
lactation assessment, and advising further investigation/action where
indicated, doesn't seem inappropriate to me.
> Here comes this new edict of Scope of Practice though that states
> all LC's
> must not contradict a hcp's advice...even if they are dead wrong!!
I agree that this is by far the "elephant in the room" with this
document. I'm not an IBCLC, but I wholeheartedly offer my support
those protesting against this. If some organisation tried to muzzle
me with this sort of wording I would be marching on their offices. I
think it causes outright legal peril to those practising, especially
in the litigious USA but elsewhere as well.
(Just didn't want to be one of the "silent 3000" on that! Up till
now, maybe some of these 3000 aren't speaking because they believe
everyone else has already expressed their feelings, or because they
are not directly affected by this.)
Lara Hopkins
family doctor in Australia
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