Unresolved Ambiguities within the Canterbury Court Decision

Defining a foolproof protocol for informed consent within medicine requires courts to quantify something that cannot be quantified. The amount of ambiguity within this court decision may have concerning consequences for patients. The court is overall reasonable in setting precedent for this complex issue. However, potential problems remain, both as a function of the inherently convoluted topic of informed consent and of certain gaps within the court’s ruling.

How much information physicians should disclose, when, and to whom, leaves room for debate. The court states the information needs to be “relevant” to the case and a reasonable person who would work on it must approve of this. The “relevance” of information is undeniably ambiguous, but perhaps this is impossible to cover with a single law, as the risks for craniectomies require more thorough explanation than those of wisdom teeth surgery, for example. The court provides an adequate incentive for physicians to notify patients of all potential, relevant risks: the patient can hold the physician liable in court for something that the physician did not warn them of and that had causal relationship from their procedure.

There remain many problems with the wide latitude of behavior legally protected by therapeutic privilege. It is hard to argue that this does not become a direct threat to patient autonomy. The lack of stipulations makes patients vulnerable to abuse, as the physician can take advantage of the patient with legal justification. Invoking this privilege during treatment for a patient with anxiety and depression who may experience distress is wrong, as they are still competent, autonomous beings. In extremely rare cases, such as delusional parasitosis, the use of therapeutic privilege may be appropriate. The court doesn’t specify the legal conditions when it is permissible to withhold information from the patient. The court seems to try to distinguish between non-disclosure and paternalism, but really what is the difference in practice? 

Another potential issue arises in the court’s assertion that physicians should not have to warn of inherent risks of surgery, such as infection, as people of “average sophistication” should already know such things. While in many cases this may be true, there is no algorithm for measuring someone with “average sophistication.” Infection is a serious complication and it is the patient’s right to be told.

There are bound to be points of contention in this court decision, as putting this principle into action ultimately becomes very legally intricate in the world of medicine.

5 thoughts on “Unresolved Ambiguities within the Canterbury Court Decision

  1. Katherine Gao

    I definitely agree with the ambiguities Iris brings up about the Canterbury ruling. The court’s decision suggests that disclosure “must be measured by the patient’s need…material to the decision,” but such disclosure is hard to achieve practically as there is no quantifiable metric to make this determination.
    If a physician is to disclose information based on what the patient believes is relevant, how is the physician supposed to know exactly what the patient deems as such? The court case often addresses this problem by ruling that physicians should assume the patient to be an “average, reasonable patient.” Iris mentions a great point about how there’s no clear measurement for “average sophistication.” Adding on to this, I think another problem is that autonomy itself implies that every individual holds different values, so assuming a patient to be an “average” patient rather than assessing situations on a case by case basis can be problematic.
    Additionally, I agree that the case should have provided more clarification on therapeutic privilege. The physiological effects of distress from disclosure are only truly clear in hindsight, so how can physicians determine when to use therapeutic privilege? And if the physician chooses to inform the patient, but the disclosure does, in fact, end up causing debilitating distress, will the physician face repurcussions? It’s clear that the court ruling heavily values a patient’s right to autonomy, but ambiguity in its mention of therapeutic privilege may make it easier to justify nondisclosure in potentially less ethical circumstances.

  2. Kris Chari

    Iris conducts a masterful analysis of the Canterbury decision. While she recognizes the court’s reasonable decision, she also poses the question of its feasibility and quantifiability. The post certainly outlines the main aspects of the case, including the reasoning behind the decision, but it goes further to examine the various problems within the ruling. For example, Iris is cognizant of how “relevance” of certain details or information can be ambiguous and subjective to both the patient and the physician. Stern regulations on therapeutic privilege are indeed required in order to ensure that patient autonomy, even in the cases of mentally impaired individuals, is not threatened. I also agree with her analysis of the “sophistication” clause of the court’s ruling. Indeed, sophistication is also infinitely complex. Along the lines of Iris’s argument, I also believe that doctors should exceed expectations and exert effort to even over-inform the patient.

    The post certainly adds a new angle to the discussion. Iris’s portrayal of the intricacies of medicine using the lens of legality shines a light on the court’s shortcomings in the ruling. She continues on to criticize the inadequate incentive placed for doctors to inform their patients, and how the consequences are not severe enough to ensure this happens. In her final conclusion, she recognizes that pragmatically instituting these principles in modern medicine can be vastly complicated, which underlines the subjectivity of the debate between autonomy and paternalism.

  3. Will Cochrane

    Overall, I think this a well thought about and written piece. It is conscious in nature and the information is accurate and relevant in today’s world. I thought it was interesting when talking about infection as a topic that may have to be discussed with the patients. This certainly in medicine does not get spoken about to the patient as much as I believe it should. Also, I found it interesting that the court rules that someone must have “average sophistication,” and how this can be distinguished. Surely it is entirely subjective in nature? I think this piece sets nice comparisons between American healthcare vs the British NHS. In the NHS because doctors are not getting paid even close to what they get here, and treatments are essentially free I wonder if it is different? Certainly, from my experience with the NHS it seems to be a more trustworthy system. I’m not saying here that American doctors cannot be trusted but I wonder if biases come in when disclosing information about a procedure to the patients and the risk. If a doctor told all the possible side effects and dangers would it maybe sacred a person out of the procedure? Would some hide this information then to keep their pay-check? Certainly, from my experiences in the UK this is not the case because money is not a factor in any means, but I find it interesting how much it may play into doctors disclosing all information about the procedures. Overall though I very much enjoyed reading the piece.

  4. Amelia Dimas

    I agree that the Canterbury Court decision lacks specificity while addressing certain issues. As you point out, informed consent is a difficult and complex issue that would be difficult to fully examine within one court ruling. However, there are subjects within the decision obviously lacking in detail. One example you gave pointed to a lack of differentiation between paternalism and therapeutic privilege, and how this lack of specificity threatens patients’ autonomy. I agree that physicians could use this ambiguity to abuse patients, specifically patients suffering from mental illness by robbing patients of their autonomy unjustly on the ground of therapeutic privilege.

    I would add to your argument that another flaw in the court decision’s argument is the ambiguous concept that the risks disclosed to a patient by a physician should be based on what a patient deems necessary to make a decision on their medical treatment. This idea highlights a flaw in many philosophical theories in that they operate around an “ideal” person, or in this case, patient. This concept ignores that patients may be fully rational, yet have differing educational backgrounds when it comes to biology and medical treatment. If a patient is lacking in knowledge on these topics, they may not be able to judge what information is relevant and would influence their decisions. Therefore, to base the extent of risk disclosure on what a patient would deem significant, may leave less educated patients vulnerable. The concept’s lack of specificity leaves room for a physician to withhold vital information from a patient because they have not expressed interest in certain information or risks.

  5. Muhammad Mukarram

    I appreciate Iris’s analysis on the Canterbury V Spence case as it delves into the various aspects of the case that make it worth learning about . From a superficial perspective, one would think that Iris is contradicting themselves throughout the analysis because both sides of the coin in the case are defended. However, that literally explains the whole point of this entry and the assigned reading itself, paternalism vs. autonomy is very tricky because of how ambigious and intangible the “rules” surrounding it are. For example, Iris explains that healthcare providers are under the assumption that patients know that surgery can lead to infection so they don’t always expand on this. However, that approach by healthcare providers can be used to defend an orthopedic surgeon who doesn’t stress the risk of paralysis from a lower back surgery because it is implied that back surgery can potentially lead to paralysis. In a more extreme example, a heart surgeon shouldn’t have to explain that the surgery could lead to death. Although these extreme examples almost never occur, it is hard to decide when a healthcare provider can stop listing out potential negative outcomes to patience, while still keeping patients informed. Hence, the difficulty in balancing autonomy and paternalism.


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