medical ethics: part II

standard of care:

this phrase has been used by quite a few health care workers and others in reference to why my back-up doctor effectively fired me at 39 weeks pregnant for refusing to agree to take prophylactic antibiotics during labor and delivery. and cited as the reason why basically all the other doctors in santa fe would refuse to take me for the same decision.

i can understand "standard of care" . . . right up to the point where i am no longer allowed to take an active role in my own healthy care . . . right up to the point where i am no longer allowed to make my own **informed** decisions for myself or my children . . . right up to the point where it becomes a mandate for debatable or questionable treatment . . . right up to the point where it is used as a catch-all scapegoat phrase that saves doctors from having to actually talk to their patients in an intelligent way.

during pregnancy there are quite a few things which are considered "standard of care." for instance, 20 week ultrasounds, gestational diabetes testing, group b strep testing, AFP tests, amnio for women over 35, monthly then bi-weekly then weekly prenatal appointments, and the list goes on.

but here's the thing, it's ok to refuse ultrasounds. md's don't like it, but they can live with it if you choose not to have one. the same thing goes for amnios in women over 35 and AFP testing. some women have even been known to refuse gestational diabetes and GBS testing. though admittedly that is probably more commonly done by women who are under the care of midwives. and more easily accepted by midwives. and no one (midwives, md's and patients alike) blinks when one or the other party misses or skips or pushes back a prenatal appointment. no big deal.

so why is it such a crime to choose not to take prophylactic antibiotics during labor and delivery? why? if the "standard of care" functions as a *guideline* in all those other cases . . . if they are options, not mandates . . . then why is this issue different? why am i suddenly wrong for making an informed decision that doesn't mesh with theirs? why is that decision actionable where the others aren't? if doctors are going to fire patients for refusing their "standard of care" shouldn't that apply equally to all? aren't they all, according to the western medical model and the standard of care, equally valid and important tests and procedures?

"because we live in a free country," you say? yeah. exactly my point. don't i live there, too?