The Supreme Court orders two gynecologists to pay 35,000 euros for using forceps without consent

BarcelonaThe Supreme Court has ordered two gynecologists to pay €35,000 in damages to a patient for using forceps and vacuum extraction during her delivery without her consent or prior notification. The ruling clarifies that, even without medical negligence, the failure to inform her beforehand about the instruments to be used and the associated risks violated her right to informed consent. The woman who brought the case to the Supreme Court to establish this precedent was 29 years old in March 2014 when she gave birth to her son in a Madrid hospital. She had received prenatal care at the same hospital in the preceding months, and all tests had come back normal. After three hours of contractions, the doctors attending her during the delivery used a vacuum extractor and forceps to deliver the baby. The postpartum period in the hospital went well, and after a few days, the woman was discharged. However, a year later, she was still experiencing pain in the episiotomy scar from her delivery. After trying various treatments, the pelvic pain persisted, and when her son was three years old, she filed a malpractice lawsuit.

The patient criticized the fact that there had been no reason to use instruments during the delivery, as the medical recommendation is to use them only after four hours of contractions. She also complained that she had not given written consent for the use of vacuum extraction and forceps, only for administering the epidural, and that she had not been informed that these instruments would be used. One of the exceptions for doctors to intervene without needing the patient's consent is when there is an "immediate and serious risk" to the patient and it is impossible to obtain their authorization. For example, if a person in critical condition is unconscious.

Patients' Rights

The four judges who signed the ruling—two men and two women—added to the decision a reflection on the "paternalistic conception" that has dominated medicine for years, "in which the doctor made unilateral decisions about patient treatment." They explained that there has been a "radical change" as the principle of autonomy of will—the right of each patient to make the most significant decisions about the course of their illness—has gained considerable ground: "The doctor is limited to informing a person of the diagnosis and prognosis of diseases, the alternatives available to science, and the risks involved, without their consent," they asserted. The judges' reflection also extended to the impact of pregnancy and motherhood on women's rights, and they insisted that "it should not deprive them of the right to self-determination that derives from human dignity." The Supreme Court's ruling marks the end of a legal battle that began in 2017. Initially, a Madrid court of first instance handled the case, awarding €305,000 in damages for malpractice—it did not deem the use of vacuum extraction and forceps unjustified. The case took a dramatic turn with the first appeal by the convicted doctors, and the Madrid Provincial Court overturned the conviction, finding insufficient evidence to demonstrate that there had been no risk to the health of the woman or the baby that would have warranted the use of vacuum extraction and forceps.