Repeat cesarean consent form for an OB to sign

This is a FABULOUS consent form for an OB to sign if he/she is forcing a mom to undergo major abdominal surgery (cesarean) and not allowing mom to VBAC (vaginal birth after cesarean). FINALLY someone can confront a doc with the risks of such a procedure.
I did not write it. A brilliant lady wrote it and is so generous to share!



A Different Kind of Consent Form
I am so irate at the lack of patient choice and the asinine mentality of doctors here. I am very, very frustrated. So, I thought I would vent some of that frustration by doing something semi-constructive. To that end, I wrote my own consent form. After all, if the doctor wants me to sign theirs, they should sign mine first.

Here 'tis.

I, the undersigned physician, have, in violation of the Consumer Bill of Rights and Responsibilities, the Emergency Medical Treatment and Active Labor Act, the Patient Self Determination Act, the ethical guidelines of the American Medical Association and the American College of Obstetricians and Gynecologists, Constitutional Law (the right to privacy and self determination protected by the 1st and 14th amendments), international tort law, and case law (of particular interest "In re A.C.", 1987, "In re Fetus Brown, 689 N.E.2d 397, 400 (Ill. App. Ct. 1997)", and "In re Baby Boy Doe, 632 N.E.2d 326 (Ill. App. Ct. 1994)") and the Patient Rights as determined by this institution, deprived my client,________________, of her right to self determination and her right to bodily integrity by ignoring her repeated refusal for delivery by repeat cesarean section. I acknowledge that by refusing to honor my client's denial of consent, I have not only violated the above laws, but I also affirm that I have used unwarranted and unethical pressure including emotional threats to my client's and her unborn child's life and safety, in my attempts to obtain such consent. I further affirm that I have stressed the risks of vaginal birth after cesarean, but neglected to inform my patient of the risks of delivery by repeat cesarean section. I further affirm that I understand, that should I resort to physical force, including but not limited to physical or chemical restraints to compel my client's cooperation, I will be guilty of criminal battery, which is defined as "any form of non-consensual touching or treatment that occurs in a medical setting".

In compensation for the above violations of my client's rights, I hereby guarantee the following:

a healthy baby, born in perfect condition, with no physical, mental or developmental defecits whatsoever, whether arising from surgery or any other cause

no complications for the infant, including but not limited to: persistent pulmonary hypertension, transient tachypnea of the newborn, respiratory distress syndrome, iatrogenic prematurity, lacerations, or hematoma

a speedy, uncomplicated post-operative recovery for my client. Specifically, I guarantee that my client shall not experience nerve damage, organ damage, hemorrhage (whether sufficient to require transfusion or not), disability or disfigurement, intraoperative or postoperative infection of the wound or surrounding skin and tissues, post partum depression and post partum post traumatic stress disorder (PTSD), and other conditions not listed here.

Signed,