Saturday, September 26, 2009

Who is responsible? - Debunking the myth of doctor liability.

Midwives in Australia as well as other countries face varying degrees of regulation and restriction. Some of this control is enshrined in law, some by monopoly of funding and access to services, while much is the accepted status quo. People don't challenge what they don't recognise as having potential to change.

Historically doctors have taken the leading and thereby controlling hand in health care. This is especially so in maternity care, and midwives around the world have in recent decades strongly resisted medical supervision of midwifery. Most Australian midwives don't recognise this fact, as they work in hospitals and their scope of practice is defined by hospital protocols. Midwives who practise privately, and autonomously, develop a midwife identity that is informed by the partnerships we develop with individual women, and that is consistent with the contemporary international definition of the midwife. Midwives who practise privately know that we are responsible for all decisions, advice, actions, and lack of action in our interactions with women who employ us as their midwives. We consult, refer, and occasionally transfer care to medical colleagues when the situation a woman in our care faces is outside our scope of practice.

The question of 'who is responsible?' with reference to the relationship between doctors and nurses is explored in a paper from the Royal College of Nursing, Australia. The arguments posed in this paper can be applied to midwifery.

Ultimate doctor liability: A myth of ignorance or myth of control?
Author: Andrew Cashin and others
Reference: Collegian Volume 16 • Number 3 • July/September 2009, Royal College of Nursing, Australia

Ultimate medical doctor responsibility for the care delivered to patients by all professionals is a myth. Legally Lord Denning dismissed the myth in the mid-20th century in England. The assumption that a medical doctor is responsible for the care delivered by nurses has not existed in English and Australian law since that time, and it has been actively refuted. Yet it is a myth that continues to circulate influencing health service, state and federal health policy. For some it is a myth of ignorance and for others it is a means of control. This paper outlines the relevant case law to debunk the myth of ultimate medical doctor control.

The current government's effort to reform maternity service provision in Australia has brought to light the reality that the myth of ultimate doctor responsibility in maternity care is alive and well in this country.

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