In the healthcare context, our language can have a big impact – including a nocebo effect. Whether we are focused on risks or benefits, recommended care or alternatives…the fact remains that there is
The Decision belongs to one impacted (in maternity care, this is the pregnant woman).
The words counsel, shared, persuade and consent are ‘tricky’ words, often used to hide an intent or when the user believes their intent is honourable. What each of these words often mean, in certain contexts, is Coerce. Let’s break it down:
”the patient was counselled” is intended to mean that the risks were discussed, but really means talked at until they submitted. This is a process of checking a box, and relieving potential liability, rather than ensuring understanding with the goal of an confident decision. It usually means limited information, curated towards compliance, in limited time at the critical point. It is a reactive context, once an issue is presented. Without time allowed to be responsive, this can be stressful and increase compliance without understanding (the default). Consent given under these conditions is unreliable.
‘Shared Decision Making’ is often misconstrued to mean the decision is shared. Shared decision making is actually a process where care centres around the individual receiving the care. That individual alone is responsible for The Decisions. It is an opportunity for care providers to understand the values and context of the individual, give generalised risks and benefits of a recommendation, and offer alternatives and time to consider. In the maternity context, this process is best done as an advanced care approach, the final decisions are made as needed…but should be based on prior understanding.
In a recent summit on Communication in Healthcare, the word ‘persuade’ was used, suggesting the purpose of communicating with patients is to convince them to comply. This is clearly fraught and disrespectful, and a barely disguised agenda. More often heard in health care contexts where the message is aimed at the population level, rather than the individual level (where counsel is used).
The trouble with consent is the assumed yes. The Con in Consent is that a presumption is made of a correct stance – that you should want to say yes, and that doing otherwise makes you lesser, different, wrong…a dissenter.
These words are used consciously, as they fit the goal – which is compliance. If we offered respectful care, we would use the words: discuss, support, listen and decide. Until these are the standard words of standard care, you must be VERY prepared.
“It’s uninformed decisions, not well-informed decisions, that lead to guilt and regret.” Alison Stuebe
Being RESPECTFULLY informed makes a positive difference. This is evidence-based, observable, essential.
see also : The Semantics of Motherhood