Source: https://www.lailascase.com/ultrasound-exam-without-consent.html
Timestamp: 2019-04-23 02:18:24+00:00

Document:
However, Laila's combined, fully corroborating, factual LMPD/OTPD/SCID did not rely on her fetus/baby being"accurately average" in size, accurately average in growth velocity or accurately average in head shape. Ironically, Laila's midwife and doctor used Laila's factual LMPD to establish her pregnancy's GA in order to schedule Laila's routine 18wUSE, but directly after the scheduling of the ultrasound exam, Laila's combined, fully corroborating, factual LMPD/OTPD/SCID and all her other key pregnancy dates were summarily obviated from all medical evidence in accordance with Directorate of Health's knowledge-obviated, medically & ethically flawed 2014 Recommendation (i.e., national medical policy) with their exclusive implementation of NCFM eSnurra Group's "method" within a government-mandated protocol of evidence-obviated medicine, all without Laila's prior, informed, voluntary, explicit consent. All of Laila's factual, key pregnancy dates were obviated from all medical evidence and any and all consideration in the practice of evidence-based medicine.
In the excerpt above, the words "We have the impression" can be updated with "We know for a fact."
The Directorate of Health's 2014 Recommendation with their exclusive NCFM eSnurra implementation corrupted the routine 18wUSE in order to implement a government-mandated protocol of evidence-obviated medicine to ensure suboptimal, unilateral ultrasound-based estimates of EDD and, therefrom, calculations of GA using the equivalent of Naegele's rule, in reverse, for all pregnancies and abortions in Norway. Laila & Edward did not know, nor had they ever been informed, the 18wUSE was completely optional and voluntary. This was only learned via research efforts by Laila and Edward, as it was never disclosed. Also, Laila & Edward were never informed one of the primary purposes of the routine 18wUSE was to replace any first-trimester ultrasound-based GA & EDD values and to replace Laila's combined, fully corroborating, factual LMPD/OTPD/SCID-based GA & EDD values with a grossly inaccurate NCFM eSnurra BPD-based EDD and, therefrom, a calculated, grossly inaccurate GA using the equivalent of Naegele's rule, in reverse.
Routine examinations in weeks 17-19.
Ultrasound examinations on medical indications.
Directorate of Health's 2004 publication: "Guidelines for the use of ultrasound in pregnancy: Use of ultrasound in the general pregnancy care and in connection with obstetric diagnosis" ("Veiledende retningslinjer for bruk av ultralyd i svangerskapet: Bruk av ultralyd i den alminnelige svangerskapsomsorgen og i forbindelse med fosterdiagnostikk") states the routine 18-week ultrasound "is part of the general pregnancy check" and that"the woman shall have information on the purpose and content of the ultrasound examination." However, there is nothing in the aforementioned document that states or implies the routine 18-week ultrasound exam is optional and voluntary; and, the only mention of consent is with respect to it being made clear that consent is not required (below). Interestingly, the no consent required was "emphasized" in the very last sentence of the publication, the literal bottom line.
"Before fetal diagnostics, cf. § 4-1, the person to be examined must give written consent".
”Før fosterdiagnostikk, jf. § 4-1 foretas, må den som skal undersøkes, gi skriftlig samtykke”.
Det presiseres at dette ikke gjelder for ultralydundersøkelser på medisinsk indikasjon eller rutineundersøkelsen i uke 17-19."
1. Routine Survey in Week 17-19 and Ultrasound Examinations on Medical indication are part of the general pregnancy check and is not considered as a fetus diagnosis.
2. The purpose of the routine survey in weeks 17-19 is to establish the term, the number of fetuses, placenta's location and to conduct an orientation study of the fetus's development and anatomy.
What was supposed to be disclosed verbally and in writing, and then discussed with Laila with respect to her routine 18wUSE is articulated in the excerpts below; excerpts which were taken from the English version: A National Clinical Guideline for Antenatal Care. Short version IS-1339/E, 12/2005, ISBN-978-82-8081-078-1, Published by Directorate for Health and Social Affairs, Norway. The Norwegian version: Nasjonale faglige retningslinjer: Retningslinjer for svangerskapsomsorgen Kortversjon - anbefalinger, IS-1339, 12/2005, ISBN-978-82-8081-078-1. Note: The second excerpt implies the routine 18wUSE ultrasound exam is part of the eight check-ups without any reference to the exam being optional and voluntary.​ Also, there is no mention of informed consent.
Level 1 a: Evidence that is based on systematic review and meta-analysis of randomized controlled trials.
Level 1 b: Evidence that is based on at least one randomized controlled trial."
Level 4: Evidence obtained from expert committee reports or opinions, and/or clinical experience of respected authorities."
√ Recommendations for practice based on the clinical experience of the group that has developed the guideline."
Level 2 a: Evidence that is based on at least one well-designed controlled study without randomization.
Level 2 b: Evidence that is based on at least one other type of well-designed quasi-experimental study."
"Guideline for the use of ultrasound during pregnancy.
Information about ultrasound during pregnancy. IS 1228B.
These brochures can be ordered from the Directorate for Health and Social Affairs, Norway.
All pregnant women are offered an ultrasound examination in pregnancy week 17-19 to determine the term. At the same examination, midwife or doctor should look for the number of fetuses, placenta placement and an orientation of the fetus's anatomy. Routine ultrasound is the best method for termination. Midwife or doctor must inform in advance the purpose of the examination, both in writing and verbally, and that the examination is voluntary.
Alle gravide får tilbud om ultralydundersøkelse i svangerskapsuke 17–19 for å bestemme termin. Ved den samme undersøkelsen skal jordmor eller lege se etter antall fostre, morkakens plassering og en orienterende undersøkelse av fosterets anatomi. Rutineultralyd er den beste metoden for terminbestemmelse. Jordmor eller lege skal på forhånd informere om hensikten med undersøkelsen både skriftlig og muntlig, samt om at undersøkelsen er frivillig.
There are several routine examinations during pregnancy. Midwife or general practitioner shall inform the background of the examinations. The information should be written and verbal.
​Moreover, Directorate of Health's website actively (and ignorantly) promotes the NCFM eSnurra "method" as "the best research-based method, and the most precise tool."
The Directorate of Health recommends using one method, eSnurra, for the calculation of pregnancy length and term (letter of December 2014, PDF). eSnurra is the best research-based method, and the most precise tool for evaluation of the term and duration of pregnancy. When using eSnurra, overtime (294 days) will occur 11 days over the estimated term date.
​The use of one method nationally ensures abortion-seeking women similarity under the law (avoiding geographical variations), will give a similar assessment of prematurity and unambiguous assessment of overtime pregnancies.
eSnurra as a national tool is readily available as a plastic wheel, mobile and tablet app and an open available web version (esnurra.no).
After making traditional ultrasound measurements of the head and thighbone, the data can be used in all modern ultrasound machines."
Interestingly, Directorate of Health's Website states that the midwife or doctor should "assess gestational age" at the 18wUSE which, of course, is very different than the assessment of term. In the excerpt below taken from Directorate of Health's Website there is no mention of either estimating or calculating term. This is decidedly strange, as it would appear Directorate of Health have switched from their 2014 Recommendation's policy of direct estimation of term via the exclusive use of NCFM eSnurra Group's "method" (i.e., the appropriated, plagiarized, misused Hutchon Method of PDEE) to a policy focused on gestational age via Naegele's rule, in reverse. Or, possibly, this new focus on gestational age is the result of confusion within Directorate of Health. For contrast, compare the excerpt below with "1.2 Ultrasound Survey in General Pregnancy Care" above. Again, NCFM eSnurra's "method" estimates the number of days remaining to birth/delivery from the date of the routine 18wUSE, thereby directly estimating term (or EDD) and, therefrom, calculating gestational age (indirectly) using the equivalent of Naegele's rule, in reverse.
"2. The purpose of the routine survey in weeks 17-19 is to establish the term, the number of fetuses, placenta's location and to conduct an orientation study of the fetus's development and anatomy.
The American College of Obstetricians and Gynecologists's Committee on Ethics reaffirmed Informed Consent: ACOG Committee Opinion Number 439.
Included below are excerpts from Directorate of Health's May 2005 National Academic Guidelines: Guidelines for Pregnancy Care, IS-1179 (Nasjonal faglig retningslinje for svangerskapsomsorgen). These excerpts demonstrate there has been much talk about ensuring a pregnant woman is provided with the information needed to make an informed decision or choice with respect to the routine 18-week ultrasound exam, but the fact is informed consent was neither requested by Laila's medical professionals nor was informed consent given by Laila. Moreover, informed consent is not possible without full disclosure of deceptively hidden conditions, implications, risks and consequences. Therefore, and with respect to informed consent, Directorate of Health talk-the-talk but they most definitely do not walk-the-walk.
Pregnancy checks are not fundamentally different from other primary health care consultations. But the controls - especially the first meeting - have some characteristics that are challenging for midwives or physicians: You should provide a lot of information, so that the woman can make a variety of informed decisions about tests and examinations."
Select which written information material you want to use. There are pros and cons with all material. The material must be offered, not rubbed on the woman. You should not inform her to death. Organize the material so that the review naturally leads to a conversation about the key topics from the woman's point of view, and the informed choices the woman will take for example HIV tests, ultrasound or fetus diagnostics."
In each routine examination, midwife or doctor should inform the woman of the purpose of the test and give her a clear notice that she is entitled to either accept or decline the test. Women should receive written and oral information, in line with WHO recommendations."
"An informed decision can be defined as the individual's thoughtful choice based on relevant information about the pros and cons of current treatment options (46). Doctors and midwives in pregnancy care should bring the best available research-based knowledge to the users (47).
"A priority goal of pregnancy care is to enable the woman to make informed decisions about all aspects of care, such as where to check, who will do them, what routine surveys she is offered and where she wants to give birth. In order to do this, the woman must receive information so that she can discuss the possibilities with the person (s) performing the pregnancy checks."
En informert beslutning kan defineres som individets gjennomtenkte valg, basert på relevant informasjon om fordeler og ulemper ved aktuelle behandlingsalternativer (46). Leger og jordmødre i svangerskapsomsorgen bør bringe den beste, tilgjengelige forskningsbaserte kunnskapen videre til brukerne (47).
Although you know more about routine examinations in pregnancy than about other aspects of treatment during pregnancy, more research is needed to find out how to best help pregnant women to make informed decisions about routine surveys. In addition, although information is likely to be a necessary factor for making an informed decision, 48 Information Guidelines for Pregnancy Care 2005 alone are not enough. Other factors also affect. The user survey from TNS Gallup showed that written information distributed in pregnancy is read by the respondents (18): "98% of prospective mothers read about pregnancy either in brochures, online or in books. It is especially the brochures you get on the controls that are read and these are also read by all social groups.""
There is a need to investigate methods of disseminating knowledge and identifying how health professionals can effectively support pregnant women to make informed decisions about studies offered during pregnancy."
Is it appropriate to use a standardized pregnancy journal as a health card for pregnant women? Should pregnant women take care of the journal herself?
"The findings from surveys and randomized controlled studies confirm that it is appropriate to have a standardized pregnancy journal that the woman herself handles during pregnancy (72-74) [Knowledge Base Level 1b]. Research supports current practice in Norway. Because the woman herself "owns" the health card, the midwife and doctor can promote user involvement and informed decisions by appropriate use of the health card: In an active collaboration with the pregnant woman, so that she understands what is noted in the appointments."
Er det hensiktsmessig med en standardisert svangerskapsjournal som helsekort for gravide? Bør gravide ta hånd om journalen sin selv?
Funnene fra spørreundersøkelser og randomiserte, kontrollerte studier bekrefter at det er hensiktsmessig å ha standardisert svangerskapsjournal som kvinnen selv tar hånd om i svangerskapet (72-74) [Kunnskapsgrunnlag nivå 1b]. Forskningen støtter gjeldende praksis i Norge. Fordi kvinnen selv ”eier” helsekortet, kan jordmor og lege fremme brukermedvirkning og informerte beslutninger ved en hensiktsmessig bruk av helsekortet: I et aktivt samarbeid med den gravide, slik at hun er inneforstått med det som noteres i forbindelse med kontrollene.") (Source: ibid., p. 57).
Moreover, Laila was not informed that since she had an ultrasound exam in her first trimester, that "there does not seem to be important differences between ultrasound in the first or second trimester with respect to term." Which means there was no medical need for NCFM eSnurra to replace GA & EDD values from her first-trimester ultrasound exam with the second-trimester GA & EDD values from the 18wUSE. That alone might have saved Laila from an unwanted, unnecessary Cesarean section surgery delivery, etc. Also, the BPD-based eSnurra EDD & GA from the first ultrasound exam on 10.08.2016 (or LMPD/OTPD/SCID-based GA = 13w+2) showed BPD-based eSnurra GA = 12w+3, lagging Laila's LMPD/OTPD/SCID-based GA by 0w+6 or 6 days and CRL-based eSnurra GA = 12w+0 , lagging Laila's LMPD/OTPD/SCID-based GA by 1w+2 or 9 days. Moreover, BPD-based eSnurra EDD = 20.02.2017 and CRL-based eSnurra EDD = 25.02.2017. So, if the BPD-based NCFM eSnurra EDD from Laila's first ultrasound exam had been used as Laila's "official" eSnurra EDD, the prediction error would have been (predicted (set to 0) - actual) = (02.20.2017 - 04.02.2017) = -16 days, or 2w+2. However, the first ultrasound exam NCFM eSnurra BPD-based EDD was only lagging Laila's LMPD/OTPD/SCID-based EDD of 14.02.2017 by 6 days, well under the umbrella of normal variance of Laila's LMPD/OTPD/SCID-based EDD. Consequently, if Laila's 18wUSE had not taken place, Laila's baby would have been routinely turned from breech to vertex before Laila went into labor. Also, and given that Laila had an NCFM eSnurra GA & EDD assigned to her pregnancy at her first ultrasound exam on 10.08.2016, this first NCFM eSnurra GA & EDD should never have been replaced with the eSnurra GA & EDD from her 18wUSE of 23.09.2016 when fetal metrics and their measurements presented greater random fetal growth velocity variances.
The U.K's National Institute for Health and Care Excellence (NICE) "Antenatal care for uncomplicated pregnancies," Clinical guideline [CG62] recommends "an early ultrasound scan between 10 weeks 0 days and 13 weeks 6 days to determine gestational age and to detect multiple pregnancies."
"given both written and verbal information in advance about the purpose of the ultrasound examination. They should also be informed that the examination is voluntary. "
a pregnant woman cannot give prior, informed, voluntary, explicit consent nor make any informed choice if a pregnant woman is made to feel medically compromised or afraid for herself or for her fetus/baby by her medical professional(s), or if a pregnant woman is made to feel ignorant (not understanding) or stupid (not able to understand) by her medical professionals if she were to say no to the Trojan horse, routine 18-week ultrasound exam.
There are several conditions, implications, identifiable risks and consequences associated with the routine 18wUSE which were neither disclosed nor explained verbally or in writing prior to the exam; and, most importantly, there was no prior, informed, voluntary, explicit consent.
If Laila was representative of how the allegedly "optional" and "voluntary" status of the 18wUSE is communicated to women in Norway, and there is a plethora of evidence to support Laila was representative, then the "high uptake" stated in the NOKC report (first excerpt above) is supported by evidence that most women were not, and are not, "given both written and verbal information in advance about the purpose of the ultrasound examination." Consequently, Norway's women are not fully informed of the purpose, conditions, obligations, implications, risks and consequences of the routine 18wUSE before the scheduling and execution of same.
However, and on the face of it, the 18wUSE appeared to be a good opportunity to collect medical evidence of fetal health, position, development and potential anomalies. So, right as Laila & Edward were feeling positive about the 18wUSE, the insidious, systemic, institutionalized problem which had been intentionally and deceptively hidden emerged. The 18wUSE had been used as a Trojan horse for Directorate of Health's knowledge-obviated, medically & ethically flawed 2014 Recommendation with their exclusive implementation of NCFM eSnurra Group's "method" within a government-mandated protocol of evidence-obviated medicine. The purpose of which was, and is, to take total control of estimating EDD and, therefrom, calculating GA using the equivalent of Naegele's rule, in reverse, for Laila's pregnancy (and all pregnancies and abortions in Norway), despite the existence of contradicting medical evidence of known, proven efficacy which, for Laila, was her combined, fully corroborating, factual LMPD/OTPD/SCID. By having been deceived about the true intent, conditions, obligations, implications, risks and consequences of the routine 18wUSE, all of Laila's key, factual pregnancy dates (i.e., LMPD, OTPD, SCID, MPMD, PTPD, menstrual cycle/period regularity, etc.) were obviated from all medical evidence and from any and all consideration in medical thinking, medical decision-making and medical actions for the duration of her pregnancy, and beyond, all the way into Laila's baby's medical birth record at the Medical Birth Registry of Norway (MBRN). This is insidious, systemic, institutionalized problem is the direct result of Directorate of Health's knowledge-obviated, medically & ethically flawed 2014 Recommendation with their exclusive implementation of NCFM eSnurra Group's "method".
If Norway's women want to reduce their risks of having an unnecessary, unwanted breech delivery or Cesarean section surgery delivery, or a baby with an unidentified, prolonged, undiagnosed, untreated FGR/malformation, or if Norway's women want to have their pregnancies tracked, managed and scheduled according to their factual, key pregnancy dates, such as a combined, fully corroborating, factual LMPD/OTPD/SCID-based GA & EDD, or just a factual OTPD-based GA & EDD, then Norway's women should just say no to the highly promoted, Trojan horse that is the routine 18wUSE which imposes, without a pregnant woman's prior, informed, voluntary, explicit consent, a government-mandated protocol of evidence-obviated medicine; a protocol proven to cause increased medical risks, critical medical mistakes and grievous medical harms (including perinatal death), unnecessarily, to some of Norway's women and their fetuses/babies. Laila wishes she had known the 18wUSE was optional and voluntary, and Laila wishes she had known of the undisclosed, deceptively hidden conditions, risks and consequences of the 18wUSE, because if Laila had been so informed, she would have just said no!
The routine 18-week ultrasound exam is marketed and heavily promoted by Directorate of Health and healthcare professionals employed by the government without full disclosure of all the hidden conditions, implications, risks and consequences to pregnant women. Moreover, Directorate of Health in conjunction with NCFM eSnurra Group do not comply with Norway's Health Personnel Act regarding the marketing of health and care services which, in this case, includes the routine 18-week ultrasound exam and the assignment of EDD & GA to pregnancies and abortions.
Marketing of health and care services shall be responsible, objective and factual.
In the marketing of businesses providing health and care services, the first paragraph applies correspondingly.
The Ministry may by regulations lay down further provisions on the marketing of health and care services, and may, among other things, prohibit certain forms of marketing.
0 Endret ved lov 22 juni 2012 nr. 46.
Patient and user have the right to participate in the implementation of health and care services. This includes the patient's right to participate in choosing between available and appropriate examinations and treatment. The form of participation must be adapted to the individual's ability to provide and receive information.
The services must as far as possible be designed in collaboration with the patient and user. It should be emphasized what the patient and the user believes the design of services for health and care law §§ 3-2 first paragraph no. 6, 3-6 and 3-8. Children under 18 should be consulted when the child's development and maturity and the nature dictates.
If the patient is not competent to give consent, the patient's next of kin is entitled to participate together with the patient.
Want patient or user that other people should be present when health care is provided, this must generally be accommodated.
0 Amended by Law 24 June 2011 No.. 30 (ikr. January 1, 2012 acc. Res. 16 Dec 2011 No.. 1252 ). Amended by Law 16 June 2017 No.. 53 (ikr. January 1, 2018 acc. Res. 8 Dec 2017 No.. 1951).
The patient should have the information necessary to gain insight into their health status and content of health care. Patients should also be informed about the possible risks and side effects.
Information should not be given against a patient's expressed will, unless it is necessary to prevent adverse effects of the health care, or it is determined in or pursuant to law.
Information may be omitted if it is urgently necessary to prevent danger to life or serious damage to the patient himself. Information can also be omitted if it is clearly inadvisable in the interests of persons close to the patient, providing such information.
If the patient or user to cause damage or serious complications, the patient or the user is informed. It shall also be informed of their right to seek compensation from the Norwegian Patient, to approach the patient and user ombudsman and the right to ask the supervisory authority for assessment of any breach of duty by patient and user Rights Act 1 § 4.7.
If the patient or user is injured or suffers severe complications and the outcome is unexpected in relation to the likely risk, the patient or user shall also be informed of the measures that the health and care service will take to prevent similar events from occurring again.
If, after the end of treatment, it is found that the patient may have suffered considerable damage as a result of the health care, the patient should if possible be informed.
Users should have the information necessary to get sufficient insight into service provision and in order to safeguard their rights.
0 Amended by laws 24 June 2011 No.. 30 (ikr. January 1, 2012 acc. Res. 16 Dec 2011 No.. 1252 ), June 7, 2013 No.. 29 (ikr. January 1, 2014 acc. Res. 6 Dec 2013 No.. 1398 ) . Amended by Act of 15 Dec 2017 no. 107 (ikr. From the King decides).
If the patient agrees or the situation so warrants, the patient's next of kin have information about the patient's health status and the health care provided.
Is the patient over 16 years and obviously can not protect their interests because of physical or mental disorders, dementia or mental retardation, both the patient and his or her next of kin is entitled to information under the provisions of § 3.2.
If a patient or user dies and the outcome is unexpected in relation to the foreseeable risk, the patient or the user's next of kin the right to information under § 2.3 subsections, as far as confidentiality is no obstacle to this.
0 Amended by laws 24 June 2011 No.. 30 (ikr. January 1, 2012 acc. Res. 16 Dec 2011 No.. 1252 ), June 7, 2013 No.. 29 (ikr. January 1, 2014 acc. Res. 6 Dec 2013 No.. 1398 ) . Amended by Law 16 June 2017 No.. 53 (ikr. January 1, 2018 acc. Res. 8 Dec 2017 No.. 1951 ). Amended by Act of 15 Dec 2017 no. 107 (ikr. From the King decides).
Is the patient under 16 years, both the patient and the parents or others with parental responsibility informed.
If the patient is between 12 and 16, information must not be given to parents or others with parental responsibility when the patient for reasons that should be respected, not wanting this.
Information needed to fulfill parental responsibility must nevertheless be given to parents or others with parental responsibility when the patient is under 18 years old.
If the child welfare service has taken care of children under 16 years after the Child Welfare Act § 4-8 or § 4-12, the first, second and third paragraphs accordingly for child welfare services.
The information must be adapted to individual circumstances, such as age, maturity, experience and cultural and linguistic background. The information shall be provided in a considerate way.
The personnel shall, as far as possible ensure that the recipient has understood the nature and importance of the information.
Disclosure of the information provided shall be recorded in the patient's or user's journal.
0 Amended by Law 24 June 2011 No.. 30 (ikr. January 1, 2012 acc. Res. 16 Dec 2011 No.. 1252 ). Amended by Law 16 June 2017 No.. 53 (ikr. January 1, 2018 acc. Res. 8 Dec 2017 No.. 1951 ).
Information on Medical and health conditions as well as other personal information shall be treated in accordance with applicable confidentiality provisions. The information must be treated with caution and respect for the integrity of the data subject.
The professional secrecy falls away to the extent that is entitled to confidentiality consents.
If health personnel disclose information that is subject to a statutory duty of disclosure, the information applies, as far as conditions dictate informed that the data is given and the information in question.
Included below are Sections 4-1 & 4-2 of Chapter 4 of Norway's Patients' Rights Act [English] or Lov om pasient- og brukerrettigheter (pasient- og brukerrettighetsloven). These 2 Sections define patient consent. The Section headings for Sections 4.3 - 4.9 are also included for the purpose of demonstrating these Sections exist but do not apply to Laila's case. Interestingly, Section 4-1, para. 2, (below) empowers a patient to withdraw consent; however, in Laila's case, Laila never gave consent to the hidden, knowledge-obviated, medically & ethically flawed terms and conditions which comprise the routine 18-week ultrasound exam. Laila and Edward argued, vociferously, against using the erroneous, grossly inaccurate NCFM eSnurra BPD-based EDD & GA values instead of Laila's accurate, combined, fully corroborating, factual LMPD/OTPD/SCID-based EDD & GA for all medical thinking, medical decision-making and medical actions for Laila's pregnancy. Consequently, because Laila never gave consent, Section 4-1, para. 2 may not apply in Laila's case. However, Section 4-1, para. 1 most definitely does apply to Laila's case. Therefore, a discussion of legal theory and case law on this point would make for interesting reading and an even more interesting judicial decison.
Health care may only be provided with the patient’s consent, unless legal authority exists or there are other valid legal grounds for providing health care without consent. In order for the consent to be valid, the patient must have received the necessary information concerning his health condition and the content of the health care.
The patient may withdraw his consent. If the patient withdraws consent, the health care provider shall give the necessary information regarding the consequences of not giving the health care.
Consent may be given explicitly or tacitly. Tacit consent is considered to have been given if it is probable, based on the patient’s conduct and all other circumstances, that he or she accepts the health care.
The Ministry may issue regulations regarding a requirement of written consent or other formal requirements in connection with certain types of health care.
Included below is an excerpt from the American College of Physicians Ethics Manual: Sixth Edition. The entirety of this manual is available via the links included below. It is interesting to note the ACP Ethics Manual has identifies the same 4 medical ethical principles above, it also contains 43 occurrences of the word "consent" and 16 occurrences of the 2-word sequence "informed consent."
"Medical and professional ethics often establish positive duties (that is, what one should do) to a greater extent than the law. Current understanding of medical ethics is based on the principles from which positive duties emerge (Table 1). These principles include beneficence (a duty to promote good and act in the best interest of the patient and the health of society) and nonmaleficence (the duty to do no harm to patients). Also included is respect for patient autonomy—the duty to protect and foster a patient's free, uncoerced choices (6). From the principle of respect for autonomy are derived the rules for truth-telling. The relative weight granted to these principles and the conflicts among them often account for the ethical dilemmas that physicians face. Physicians who will be challenged to resolve those dilemmas must have such virtues as compassion, courage, and patience.
An effort was made to determine if other Nordic countries had the same ethical issues as Norway with respect to securing valid, prior, informed, voluntary, explicit consent from pregnant women for the routine 18-week ultrasound exam. It was learned Sweden's Statens beredning för medicinsk och social utvärdering (SBU) (The state's preparation for medical and social evaluation), which appears to be the equivalent of Norway's National Knowledge Center for the Health Services (NOKC), authored the report "Rutinmässig ultraljudsundersökning under graviditet" ("Routine ultrasound examination during pregnancy") which confirmed women in Sweden had received inadequate information about the routine 18-week ultrasound exam and, therefore, women in Sweden were not able to provide valid, informed consent. The Swedish report, prepared by SBU, specifically cited the requirements of the medical ethical "autonomy principle" as problematic with respect to the routine 18-week ultrasound exam. And, the same is true for the women of Norway, as there is no evidence the "autonomy principal" or any other principle of medical ethics was applied in Laila's case,or the cases of other women in Norway.
"Routine ultrasound examination during pregnancy can be discussed in accordance with the four ethical principles: goodness principle, suffering principle (no harm), justice principle and autonomy principle."
The following list summarizes the key Directorate of Health publications, Norwegian laws and medical ethics principles regarding informed consent with respect to the hidden purpose, conditions, obligations, implications, risks and consequences which constitute the routine 18-week ultrasound exam.

References: § 4
 § 4
 § 4
 § 3
 § 2
 § 4
 § 4