Dr. Crippen's theoretical post about 'medical rape' got me thinking.
Consent is a funny issue with lots of people in the sphere of healthcare. I try to see it as a bit of a black and white issue, as it's easier.
The situation is thus:
You are a hospital doctor, working in obstetrics. You are called to the Labour Ward by the midwifes. Ms Smith is a 29 year old barrister and is in labour. Her partner, aged 32, and also a barrister, is with her. It is her first baby and she is towards the end of the labour which has been uneventful but a little longer than expected. She declined an epidural. She has, at her own request, had only “gas and air” for analgesia. She has been fully dilated for nearly an hour. She was pushing well at first but, suddenly, she is very tired, and she can no longer push effectively. The foetal heart rate has dropped suddenly and precipitously. The baby’s head is on the perineum, but Ms Smith cannot push it out.
The baby must be delivered quickly. You tell Ms Smith that she needs to have some help, that you need to do a forceps delivery. She is close tears and exhausted. She agrees. “Yes, please, just deliver my baby as quickly as possible.” Ms Smith is put up in the stirrups. You infiltrate some local anaesthetic, put the forceps on the baby’s head without difficultly and are about to do what the obstetricians (not the patient) would call a “simple lift out”. You start to apply gentle traction on the forceps. The baby’s head begins to move easily. At this point, Ms Smith starts to scream, “No, no, no, stop, take those bloody things out of me now.” Ms Smith’s partner mops her brow. She continues to scream, “Take those bloody things out of me”. You ignore her request saying “it won’t take a minute” and continue to increase traction on the forceps. Ms Smith screams more and keeps saying “take them out, take them out.” Twenty seconds later, the baby’s head is born, and you remove the forceps. Ms Smith stops screaming. The rest of the birth continues without problems. The on-call paediatrician is present. The baby has a low Apgar at one minute but then pinks up very quickly and is handed to the mother alive and well.
In my comment on DC's site, I mention how I'm not sure what'd happen if the Doc would've removed the forceps at the moment the pregnant refused. For example, if this would've caused damage to baby and/or mother than the doctor is in an ethically screwed area. On one hand, s/he does something for the best: to sort out a problem and keep both parties as healthy as possible whilst running the risk of being called a rapist. On the other, s/he takes notice of the patient and lives with the consequences. This could, essentially, go against ethics or morals. To do no harm, and to do good, specifically.
Even so, I'd go with the latter option. There might not be a court in the land who could try and prosecute a doctor for doing what s/he thought was right, i.e. delivering the baby, however in this new consumer-obsessed world of 'choice' and the like, the latter choice would be the one for me. As long as you've explained what you want to do (before doing it) and then, once the patient has asked you to stop, explained what the consequences of not doing/completing the procedure, I don't see the problem in stopping. If the patient complains about it in the future, you could just play the old 'respecting your wishes card'.