Informed Consent
What is informed consent?
The legal doctrine of informed consent requires doctors to provide patients with sufficient information to make an informed decision about their medical care.
In forensic psychology, informed consent involves a comprehensive process where individuals are fully informed about the nature and purpose of a psychological assessment or evaluation in a legal context, including potential risks, benefits, and limitations, before they agree to participate.
What is the background of this case?
Title: Canterbury v Spence
Date of case: Argued on December 18, 1969, decided on may 19, 1972, and a rehearing was denied by the United States Court of Appeals on July 20, 1972.
Plaintiff: Canterbury
Defendant: Spence and Washington Hospital Center
Type of case: medical malpractice
What is the background of the case?
Date of case: Opinion filed April 9, 1960
Plaintiff: Irma Natanson
Defendant: Dr. Kline and St. Francis Hospital
Type of case: medical malpractice
What is the background of the case?
July 10th, 1973
Michigan’s Civil Procedures Court
Plaintiff v State Dept of Mental Health
Type of case: Medical Malpractice
What is the duty to disclose as a physician?
According to the American Medical Association (AMA) doctors have a duty to disclose information to patients enabling them to make informed decisions about their medical care, including the condition, treatment options, risk, benefits, and alternatives.
What was the legal issue in the case Canterbury v. Spence?
Whether Dr. Spence had a duty to disclose the risk associated with a medical operation
What was the primary legal question in Natanson v. Kline?
Dr. Kline had a duty to disclose the risks of a medical procedure, including the potential for serious bodily injury or death, and what standard of disclosure was required
What was the legal issue in the case Kaimowitz v. Michigan DHM?
The legal issue at hand was whether a mental patient is able to give consent to a major surgery when they may not be thinking in their right mind and also whether the surgery would violate rights given to the patient by the constitution (8th amendment).
What type of information is disclosed in informed consent?
The patient’s condition, the nature of the proposed treatment, anticipated results, possible alternative treatments, serious risks and complications, benefits and risk that may be significant to the patient.
What were the contentions of both parties?
Canterbury: (plaintiff) Argued negligence in surgical procedure, failure to disclose, negligent post operative care.
Spence: (Defendant) stated that he had no duty to disclose, denial of negligence during operation/ post operation.
What were the circumstances leading to the Natanson v. Kline case?
Irma Natanson undergoing a radical left mastectomy for breast cancer on May 29, 1955, and later hiring Dr. John R. Kline, a radiologist at St. Francis Hospital, to provide cobalt radiation therapy, which she claims was negligently administered, resulting in injury.
Dr. Kline and St. Francis Hospital denied the allegations of negligence, asserting that they had provided appropriate care and had not been negligent in their treatment or administration of the therapy.
What lawsuit did Kaimowitz file?
Kenneth Kaimowitz filed a lawsuit to challenge the surgery, citing ethical concerns and violations towards the patient that was getting the surgery.
A man named Louis Smith in the Michigan mental health system who was there because of the raping and murder of a woman, signed a document allowing doctors to preform a surgery that would involve the “treatment of uncontrollable aggression”.
Kaimowitz argued that because of the man's incompetence he should not be able to give consent to major brain surgery.
What are the 3 kinds of informed consent?
Written- A signed and dated document that outlines the terms of the consent
Verbal- An oral agreement between the patient and the healthcare provider.
Implied- inferred from the patient’s actions, such as accepting a treatment.
How did the courts rule and why?
The court rejected the idea that medical practice custom determines the duty to disclose, instead asserting that the law should set this standard.
Court recognized that true consent required informed exercise of choice (patients have opportunity to evaluate the options and risks involved) and that the duty to disclose is based on the patient's right to make decisions about their body
What was the Kansas Supreme Court’s ruling in Natanson v. Kline regarding a physician's duty to disclose risks?
The recognition of a physician's legal obligation to inform patients of significant risks under the doctrine of informed consent, while also upholding the lower court’s finding that Dr. Kline was not negligent in administering the treatment?
How did the courts rule and why?
The judge sided with Kaimowitz in that one who is not mentally sane, cannot give legally adequate consent to an innovative and experimental surgery on the brain. The court recognized the incompetence that Louis Smith had and that there needs to be a framework of the informed consent doctrine, as there was no definitive answer.
The experiment had raised several ethical concerns in regard to human rights, specifically in regards to the constitution, as the standard of due process could be seen as being removed. The court acknowledged that the patient’s first amendment rights would be violated, specifically due to the patient being incarcerated. It was also stated that his ability to “generate ideas,” when agreeing to this procedure within an involuntary containment period, was a direct violation of these rights.
What psychological, practical, and life implications changed as a result of this case?
This case clarified that physicians have a duty to disclose material risk of treatment, allowing patients to make informed decisions about their own care.
How did the Natanson v. Kline ruling influence medical law?
The establishment of a patient’s right to be fully informed before receiving treatment, helping to shape the modern understanding of informed consent.
How did psychology practices change due to Kaimowitz v. Michigan DHM?
House Bill 68523 would expressly prohibit all types of brain surgery intended to alter human behavior. The punishment for violation would be a ten thousand dollar fine.
The second bill in the Senate would deny federal funds to any organization, institution, hospital, or foundation involved in activity where human subjects are at risk. This activity would include any research where a human is exposed to the possibility of physical, psychological, or sociological harm.