Possibility of a paralysis

1. Salgo versus Leland Standford University Board of Trustees The term “informed consent “was introduced in this court case in 1957. Martin Salgo was experiencing leg cramps and to determine the cause of his pain consented to undergo translumbar aortography. After the operation, when trying to use the bathroom he fell from his bed and was then paralyzed. Salgo sued his physicians arguing that they failed to warn him of the possibility of a paralysis if he will undergo the procedure (Faden et al. , 1986, p. 125).

The court made a decision in favor of Salgo, stating that “a physician violates his duty to his patient and subjects himself liability if he withholds any facts which are necessary to form the basis an intelligent consent to the proposed treatment”( Wilson, 1997, p. 55). This court decision brings a new proposition in medical ethics which obligates the physician to disclose risks and other alternatives that may be open to the patient as well informing the latter of the nature and consequences of the treatment procedure.

This decision is very important since until the mid-twentieth century there is no known evidence that consent for medical research had been sought (Faden et al. , 1986, p. 125). 2. Arato versus Avedon This case occurred in 1993. Mr. Arato was diagnosed with a kidney failure and upon surgery to remove the kidney; a tumor was discovered in the distal part of his pancreas. With his consent, Mr. Arato’s spleen and infected parts of pancreas were also removed. Mr. Arato then undergoes chemotheraphy upon the advice of his oncologists (chief oncologist, Dr. Avedon).

But then Mr. Arato shortly died and his wife complained that he was not informed of the statistical data of life expectancy; had he known that his time left on earth was brief he would have chosen not to undergo the treatment and order his affairs accordingly. Moreover, his family may have avoided financial losses as a result of his death. In this case, the Supreme Court affirms the decision that physicians are liable to inform the patient of statistics concerning life expectancy so that the latter can align his activities to his anticipated death.

3. Schloendorff Case This case provides the early concept of informed consent as stated in its 1914 court decision. In 1908, Schloendorff suffers a disorder in the stomach and while subjected to an abdominal examination her physician removed a fibroid tumor while she was unconscious. The problem was, although Schloendorff agreed to the examination, she made it clear that there should be no operation. Schloendorff suspected that because of that operation she developed gangrene in her left arm which causes the amputation of some of her fingers.

In the court decision of this case, the patient’s right to self-determination was stressed by Judge Cardozo who states, “every human being of adult years and sound mind has a right to determine what shall be done with his own body; and a surgeon who performs an operation without his patient’s consent commits an assault, for which he is liable in damages”. This sets forth the idea of the supremacy of the patient’s decision regarding treatment, regardless whether an administered treatment without his consent was beneficial or not (Faden et al. , 1986, 123).

Canterbury versus Spence This 1972 case was the first and most influential landmark on decisions regarding informed consent with emphasis to self-determination. The 19 year-old patient complained of a severe back pain and was advised by his doctor, Dr. Spence, to undergo laminectomy (excisions of a posterior arch vertebra). After the operation, while voiding, the patient fell from hospital bed, and several hours after that suffered major paralysis from the waist down. He had not been informed that the procedure carries approximately a 1% risk of paralysis.

He was then operated the second time but his condition did not get better, but on the contrary, he never get well, going from one urologist to another for complications as well as requiring crutches to walk. The courts states that the risks of possible paralysis should have been disclosed before the first procedure for it would have helped the patient to make intelligent decisions and assess available options and consider the risk. The law’s continuing emphasis on self-determination was more carefully expounded in Canterbury case (Faden et al. , 1986, p. 133).

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