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J R Soc Med. 2001 July; 94(7): 372.
PMCID: PMC1281623

Reducing risk by improving standards of intrapartum care

The article by Peter Young and colleagues (May 2001 JRSM, pp. 226-231) makes depressing reading for those of us who believe that medical management should be adjudged by outcome in terms of somatic or psychic wellbeing. What it shows is that mismanagement (increasing unnecessary intervention) is likely to reduce the number and/or scale of compensation awards to the parents of brain-damaged babies, albeit it is acknowledged that fetal and neonatal brain damage is extremely unlikely to be the result of not undertaking such intervention or to be reduced by making it mandatory; in other words, the transaction is purely a matter of what is or is not regarded as optimal care by a judge and jury misled by expert witnesses citing arbitrary standards or by a sentimental feeling that parents of brain damaged babies should be given the benefit of the doubt even at the expense of the truth, the good repute of the professional birth attendants concerned, and of NHS funds. This will result in cutting back aspects of patient care of proven value in order both to pay the damages awarded and for the meddlesome measures designed to persuade the courts that no possible negligence was involved. Is this really the kind of ‘medicine’ that we want; or should we offer financial succour to those in need of it regardless of whether anyone is to blame for what is in effect an inevitable statistical fall-out of our hazardous way of reproducing ourselves. Where there has been real negligence, the authorities on whom the cost falls could then themselves recover it by due legal process without the onus of doing so falling directly on the injured party. Much anxiety, delay and expense could thereby be avoided and funds made available by the taxpayer for the alleviation of misfortune would not end up mostly in the pockets of lawyers but of those in need.

Articles from Journal of the Royal Society of Medicine are provided here courtesy of Royal Society of Medicine Press