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Setting a human rights and legal framework around ‘the ethics of consent during labour and birth: episiotomies’
  1. Bashi Kumar-Hazard1,2,
  2. Hannah Grace Dahlen3
  1. 1 Law, University of Sydney SCIL, Sydney, New South Wales, Australia
  2. 2 Human Rights in Childbirth, (NGO), San Francisco, California, USA
  3. 3 Midwifery, University of Western Sydney, Penrith South, New South Wales, Australia
  1. Correspondence to Dr Bashi Kumar-Hazard, Law, University of Sydney SCIL, Sydney, New South Wales 2050, Australia; bashi.hazard{at}

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We commend the authors for their comprehensive discussion on consent and episiotomies.1 They correctly observe that informed consent for all proposed interventions in maternity care is always necessary. The claim that consent for maternity health services does not always have to be fully informed or explicit, however, is erroneous. We are especially concerned with, and surprised by, the endorsement of ‘opt-out consent’. ‘Opt-out consent’ (a.k.a. substitute decision making) is already standard practice in maternity healthcare, with obstetric violence a normalised response to conclusive refusals or requests for explanations.

Informed consent is based on the fundamental human rights to bodily autonomy and integrity, which healthcare providers are obliged to respect. Healthcare structured around human rights violations is not care. It is cruel and inhumane treatment—a violation of yet another fundamental human right—and a reflection of poor-quality care. To be valid, consent must always be informed, specific, timely, freely given and reversible. The provider must provide information specific to each and every proposed intervention in a timely manner. The consumer has the right to consider, freely accept or refuse before providers can act. They can also change their mind at any time.

Provider attempts to substitute consumer decision-making rights constitute assault and battery. Whether the infraction was major or minor is of no consequence to human rights law. National courts create artificial …

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  • Contributors The majority of this paper was written by BK-H. Healthcare analysis, edits and final review was done by HGD.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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