Patients Have Right To Know Options
27 Jul 2007
July, 1999 - New Jersey - When is the "informed consent" of a patient necessary before a physician can recommend or commence treatment? It has been argued by some in the medical profession that "informed consent" is required only for invasive procedures. The New Jersey Supreme Court has now ruled that doctors have a duty to explain the risks of non-invasive treatments, as well as more aggressive alternatives such as surgery.
The ruling means that patients have a right to know about medically reasonable choices, regardless of whether bed rest or surgery is recommended. "Otherwise, the physician, by not discussing these alternatives, effectively makes the choice for the patient," the court wrote.
The case involved a 90-year-old woman who fell and broke her hip in 1990. An orthopedic surgeon ordered "bed-rest treatment," rather than surgery to insert steel pins into her hip. The bed rest left the patient unable to walk.
Court records show that the surgeon considered three factors in deciding his patient's treatment: her weak condition, the deterioration of her bones from osteoporosis, and a stroke 40 years earlier that had left her partially paralyzed.
Shortly after the bed rest began, the patient's right femur shifted, leaving one leg shorter than the other as the fracture healed. As a result, she was unable to walk again. Before her fall, the patient had lived independently in an apartment complex for senior citizens.
It was claimed in the lawsuit that the patient would have opted for surgery, despite the risks, if she had known that bed rest was likely to leave her unable to walk. But she was never told that surgery was an option.
"Informed consent is basically required for every medical decision," said Dr. Herbert Rakatansky, chairman of the AMA's council on ethical and judicial affairs. Sometimes informed consent is explicit, as in surgery and drug trials. In other situations, it is handled less formally, he said.
The opinion of the New Jersey Supreme Court assures that doctors who fail to properly obtain the "informed consent" of their patients for even non-invasive treatment may be held liable in the event the result of the treatment is bad. In a sense, it would be malpractice to fail to properly inform a patient of reasonable options to the care recommended.
