{"id":3124,"date":"2017-02-02T14:00:19","date_gmt":"2017-02-02T13:00:19","guid":{"rendered":"http:\/\/stg-blogs.bmj.com\/medical-ethics\/?p=3124"},"modified":"2017-02-02T14:00:19","modified_gmt":"2017-02-02T13:00:19","slug":"chappell-on-midwives-and-regulation","status":"publish","type":"post","link":"https:\/\/stg-blogs.bmj.com\/medical-ethics\/2017\/02\/02\/chappell-on-midwives-and-regulation\/","title":{"rendered":"Chappell on Midwives and Regulation"},"content":{"rendered":"

Richard Yetter Chappell has drawn my attention to this<\/a><\/span> – a blog post in which he bemoans the Nursing and Midwifery Council’s rules about indemnity insurance, and the effects that they’ll have on independent midwives.\u00a0 (I’d never heard of independent midwives – but an IM – according to<\/a><\/span> Independent Midwives UK – is “a fully qualified midwife who has chosen to work outside the NHS in a self-employed capacity”.)\u00a0 In essence, what’s happened is that the NMC has ruled that the indemnity cover used by some IMs – around 80, nationwide, according to some reports<\/a><\/span> – is inadequate; these 80 IMs (out of 41000!) are therefore barred from working.<\/p>\n

I’ve got to admit that this seems like a bit of a storm in a teacup to me.\u00a0 For sure, there may have been infelicities about the way that the NMC handled its decision.\u00a0 That may well be unfortunate, but it may not be all that much to get excited about.\u00a0 However, Chappell makes two particularly striking points.\u00a0 The first is his opening claim, in which he refers to this as “a new low for harmful government over-regulation”.\u00a0 Well, it’s not really government overregulation, is it?\u00a0 It’s the NMC.\u00a0 Governing bodies are not government.\u00a0 And whether it’s overregulation at all is a moot point: we need more information about what the standard is by which we should assess any regulation.\u00a0 That leads us to the second striking thing that Chappell says, to which I’ll return in a moment.\u00a0 Whether it’s harmful is also a moot point.\u00a0 I mean, it may be true – as he points out – that the decision will have an undesirable impact on the relationship between some women and their chosen midwife.\u00a0 But that won’t tell us anything about whether the policy is desirable all told.\u00a0 It’s certainly not enough to warrant calling it “unethical” – and to dub something unethical is not a moral argument.<\/p>\n

The second striking thing is this:<\/p>\n

It’s arguably wrong for the law to require indemnity insurance of independent midwives at all: The costs are of course passed on to clients, and it’s not obvious what legitimate interest the state has in forcing<\/i>\u00a0expectant parents to pay for such cover. \u00a0I understand that in previous decades clients of independent midwives could just sign a waiver indicating that they wished to have midwifery care without such indemnity cover in place. \u00a0I would prefer to still have that option. \u00a0So I think the law is wrong.<\/p><\/blockquote>\n

That seems to me to be somewhat questionable.\u00a0 The cost being passed to clients strikes me as being neither here nor there: if you choose a non-NHS midwife, them’s the breaks.\u00a0 And as for the legitimate interest the state has in forcing expectant parents to pay for the cover: well, again, there’s a lot being smuggled in under cover of the word “legitimate”.\u00a0 It might be paternalistic of the state to require this; but unless you think that all paternalism is so self-evidently wrong as not to require further argument to that effect, there is more that can and should be said.\u00a0 It might be that paternalism is at least sometimes wholly justified, and that this is one such case.<\/p>\n

But even if you are a fundamentalist about paternalism, it strikes me that allowing women to waive indemnity cover misses an important aspect.\u00a0 Admittedly, I’m not up to speed on indemnity insurance or – frankly – midwifery; but it strikes me that there’s at least two parties in a natal context whose welfare might be seriously jeopardised by a mistake: the mother, and the child(ren) being born.\u00a0 Therefore there’s at least two parties who may have an interest in whether or not the midwife is indemnified.\u00a0 A waiver may be foolish, but if you’re only being a fool to yourself… well, fine.\u00a0 Signing a waiver on behalf of the child-to-be, though, seems to be qualitatively different.<\/p>\n

On top of that, one might want to know more about the context of the waiver.\u00a0 Chappell points out that there’s\u00a0 a relationship between midwife and woman that’s important to preserve.\u00a0 Fair enough.\u00a0 But, given the woman’s investment in the relationship with a particular midwife – and for much of Chappell’s position to be compelling, we have to accept that it’s a relationship of a certain sort, with rather a significant investment from the woman – may it not be the case that even if she does sign a waiver, she does so in a Hobson’s choice sort of context?<\/p>\n

Or have I missed something important in all of this?<\/p>\n","protected":false},"excerpt":{"rendered":"

Richard Yetter Chappell has drawn my attention to this – a blog post in which he bemoans the Nursing and Midwifery Council’s rules about indemnity insurance, and the effects that they’ll have on independent midwives.\u00a0 (I’d never heard of independent midwives – but an IM – according to Independent Midwives UK – is “a fully […]<\/p>\n

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