The Myth of Informed Choice

💥 Just another note on HCPs who proclaim that they are fully supportive of choice, as long as it’s informed 💥

I have been ruminating on this 🙄

Ok, it sounds very positive at first glance, doesn’t it?

Who would have an issue with informed choice 🤔?

Informed choice is good, right?

Well. It depends a little 🙃.

Who decides what info someone requires to make the choice ‘informed’?

And what if you don’t actually want an information overload?

In my experience ‘I support choice as long as it’s fully informed!’ usually means: ‘you can do what you like as long as you listen to me tell you why it’s a bad idea.’

I know, I can feel some people’s hackles rising 🥴.

Especially if they feel they are giving information to make people’s experience more safe in their eyes.

However, attempting to make people’s experience ‘more safe’ often equals ‘making their choices more aligned with what they would choose for themselves.

Take the example of freebirth for example….. very topical 😳.

Generally, midwives want to tell people ALL ABOUT the obstetric emergencies can can occur when they are not around.

And of course that is very appropriate if it is a *consented to, desired and nuanced* discussion. Can be life saving, quite literally.

However, it often ends up as a scaremongering session, with the intention to change people’s minds, or even threats of social services involvement (yes, that happens, not infrequently!).

And why is it that it’s always the HCP professional who decides what information someone needs and what informed means 🤔?

And WHAT is the *right* information?

Is it what the consultant says?

The NICE guidelines?

Research studies?

Sarah Wickham’s writings?

Sam Gadsden’s collected information and peer support in her (much needed) Freebirth group? Who decides?

Some people may prefer a different type of information, from different sources, maybe even from within themselves only.

THAT IS OK.

Can this be uncomfortable for us as HCPs? You betcha!

Can it make us vulnerable as HCPs? Sure 😩.

But why is it that we hold people making *unusual* choices to *different standards* to people simply going along with the normal care pathway??

Most of us midwives would feel very happy to (insistently) tell their clients about the risks of unattended (by HCPs) birthing.

But they generally would not feel the need to tell a ‘low complexity’ birther that hospital birth is more risky for them than birthing at home, would they?

And we would also not feel particularly worried about people going along the normal care pathway despite not at ALL making informed choices.

Why? Maybe because it’s not REALLY about informed choice, is it? It’s all about *perceived* risk reduction and a discomfort with people making autonomous choices.

Discuss 🙄