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Fri Jul 20 19:39:50 BST 2007

Ken,

this is a probably common, but not a tough case:
> A 19 year old woman is in full labor, with her first pregancy...  Can she give  
> PERMISSION for the spinal anesthesia?
>   
In Germany a patient has to be able to understand what is happening to
him. This starts - depending on mature, education, disabilities, blabla
- around the age of 14 (this is of course, not God given - it is just
what will bless you in court...). This lady is 19 y/o - so no problem.
> - snip - but we have a problem.     She is severely  hampered by a mental 
> health problem and the psychiatriast has written note in  the chart that the 
> patient cannot give permission for herself. - snip -
> What to do?
>   
There are to possibilities: the obstetrician declares there is *absolute
no danger for mother or foetus* and it is save and standard of care to
wait for a judge to order a decision - well, than wait. Next option (and
in my mind the obvious and only option) is, the obstretician declares it
an emergency and does whatever is good clinical practice in these cases.
But who am I? Just a humble hillbilly surgeon.
> While calling for help, it is discovered that there is a phone number in  the 
> purse of the patient of a grandmother in a distant city.   Can  this 
> grandmother give permission?   
In my country? No!! Would she been called and asked to give permission
anyway? You bet!
> - snip -  She hangs UP.     What to do?
>   

See above - this is meaningless. Go back to answer #2
> - snip - She calls that judge for  "advice" ...  "Call back Monday" message is  
> heard.      What to do?
Next time you better have a pre-arrangement with the court. This works
at many places. Why shall not a judge spend his weekend with a cellphone
in his pocket? Doctors do it many times....
> You guessed it.   The chief of OB calls YOU and asks for the  options? 
Offer him to go look for an expert in obstetrics. ;-)

Good luck!

Mathias

PS: if you are the one who managed this case succesfully you are
entitled to pick the name of the newborn.... Or we do a poll on trauma-l!

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