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outdated in a world that upholds patients' rights and is (I hope)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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