by Bonita Katz, BA RN ICCE ICBD IAT CLC
Words are important. They frame concepts and shape our ideas. How we think is often influenced by the words we use. With that in mind I would like to consider two overlapping concepts often used in healthcare.
These words express the idea that each person has a right to choose what is right for them. Facility, provider, treatment, or procedure – each person should have the freedom to decide what they would prefer in any given situation. But look again at the phrase “informed consent.” What response does the word “consent” imply? If we truly want each person to make their own decisions we must remove our preferences from the process as much as possible. Let’s call it informed decision-making.
The Agency for Healthcare Research and Quality (AHRQ) defines shared decision making as “a model of patient-centered care that enables and encourages people to play a role in the medical decisions that affect their health.” The American College of Obstetricians and Gynecologists (ACOG) states that “decision making is a continuum with the physician leading the discussion on one end, and with patients making the decision on the other end. Although medical knowledge is tipped toward the provider end of the continuum, in shared medical decision making, a middle ground is sought that incorporates sound medical care and a patient’s personal preferences.” The American College of Nurse-Midwives (ACNM) describes shared decision making as “a partnership in which the woman and provider share information and values to make the best decisions regarding a plan of care.” These definitions accurately describe shared decision making – a collaborative process between provider and patient. But consider this: Who decides if medical care is necessary? Who decides which facility or provider to see? Who decides whether or not they will follow the recommended treatment plan? These very basic decisions are not shared. They are choices made by the pregnant person. Making wise decisions requires accurate, evidence-based information. She may choose to ask advice from any number of people, but she is the one that makes the decision. Her autonomy (her right to make her own decisions without coercion from others) must be respected. This is informed decision-making.
Since its inception ICEA has held firmly to two ideals: family-centered care and informed decision-making. The circle of care graphic illustrates the autonomy of the pregnant person. She is responsible for selecting other members of the circle and soliciting information, advice, care, and support from them. Members of the circle may consult with one another and offer advice and suggestions, but the ultimate choice for care resides with the individual. In the case of care for pregnancy and birth, that individual is the pregnant person herself. Words are important. They shape how we think about the world around us. Consider how the words you use influence your thinking and the thinking of those around you. Then… make an informed decision about the words you use.