Hospital: _______________________________
I, (Patient’s Name) _______________________, insist that my Placenta (as part of my body & my property) be released to me.
I refuse to allow the Hospital (for any reason) to withhold my Placenta, or take it to Pathology without my written & verbal consent.
I claim personal, religious, and cultural reasons for keeping my Placenta and not allowing the Hospital to withhold, or contaminate it by taking it to Pathology.
In California, there are no specific laws prohibiting the release of my Placenta, and a major legal precedent (Swanson v. Sunrise - July 2007) established my rights to keeping my Placenta.
I will sign a “Release of Liability” or “Specimen Release Waiver” to fully release the Hospital of any legal responsibility or liability regarding my Placenta.
I have full legal rights to “Informed Refusal” and am invoking that right at this time.
Any attempt the Hospital and/or Medical Staff makes to refuse release of my Placenta will legally constitute a "trespass to the person" (assault and/or battery), since the Placenta is in fact, part of my body.
I will seek legal counsel and a Court Order if my Placenta is withheld, or taken to Pathology without my written & verbal consent.
___________________________
(Patient’s Full Name)
___________________________ __________
(Patient’s Legal Signature) (Date)