The opinion in Canterbury v. Spence provides a great opportunity for discourse on the patient’s right to informed consent, which sometimes opposes what the physician may think is best for their patient. Just as soon as there is a rule regarding guidelines to informed consent, there is bound to be an exception to that rule.
As this case so clearly demonstrates, it is far from uncommon for a physician to be sued for malpractice in the event that something has gone wrong. Because of this constant threat, one might think that doctors would be completely on board with informing their patient as thoroughly as possible, if only to prevent cases like Canterbury v. Spence from happening. While ideally the fear of malpractice suits should not be the only factor motivating physicians to fully inform their patients, it may be a good starting point.
While Dr. Spence claims to have withheld the information because he had the patient’s wellness in mind, it seems reasonable that Canterbury may have been better served by being completely informed. When a minute but potentially significant risk is involved, it may be better to over share, especially if the patient is of sound mind, as Canterbury allegedly was. At that point, the patient has all the cards in his hand and makes a fully informed decision. This would also bring into account the relationship between the patient and physician. Ideally, the physician would be able to inform the patient of all potential risks and still trust that the patient would have enough faith in the physician’s educated opinion on what the course of action should be, as the doctor is clearly more well-versed on current medical practice.
An interesting point that O’neill brings up in his article “Some Limits of Informed Consent,” is how problematic informed consent can become when relating to issues of public health policy. The examples he gives are those of water purity levels and food safety requirements. It is simply not feasible to adjust these levels or regulations to individual choice, and it is unreasonable to assume that each individual would have the knowledge necessary to make a decision like that. The reason we have professionals who devote their lives to this field of study is for precisely that reason, and for the most part, we do well in trusting their expertise.
O’neill, O. “Some Limits of Informed Consent.” Journal of Medical Ethics 29.1 (2003): 4-7. Print.
5 thoughts on “Canterbury v. Spence”
I agree with your comments about the physician-patient relationship, that we generally do trust doctors with medical courses of action because they are experts. However, I feel that the “trust line” can be blurred, especially when meeting with a new doctor. The new physician may not have all your medical records and even if he or she does, does not mean that they reviewed them in detail. I feel like both the physician and patient should get to know each other on mutual grounds. I would be very skeptical of a physician who didn’t ask me questions about my condition and just saw me as a group of treatable symptoms instead of an individual. To gain trust, information should be exchanged on both ends during the formation of a new patient-physician relationship.
We both came to a similar conclusion about trusting the expertise of a doctor, but we took opposite paths.
I actually wrote in my blog post that this is not often the case. Patients, unless exceptionally well-versed in biology and medicine, can’t really grasp the underlying scientific reasoning for why one option might be better than another. Any teaching or explaining that a doctor can do is not only over simplified by necessity, but it is often going to be presented so that there is a bias towards what the physician thinks is best. So patients often end up with a rigged hand. I don’t think this is necessarily bad. Good physicians don’t intentionally give a biased view. But because they have a certain level of confidence in their judgement and knowledge, they automatically relay the situation the way they see it. So it’s not necessarily bad. Doctors who don’t make decisions aren’t really doing their job. They’d just be diagnostic machines.
Exactly, the doctor knows what’s best, and we are arguing the right to autonomy and informed consent while so often, patients blindly trust the doctor because they are the experts. This is isn’t to assume that doctors make zero mistakes, though… It’s actually so interesting that doctors buy malpractice insurance for protection against these common lawsuits. Suing for malpractice is a funny thing sometimes, because a lot of mistakes could have been avoided if the correct protocol was followed in the first place. In the cause of autonomy and informed consent, you’re right- the areas could get a little grey. I found an article that talks about the paradox of our malpractice system in the US. It makes healthcare and expensive thing for everybody involved. At one point, the doctor who wrote the article says a “fear of a lawsuit trumped all other thinking” and he ordered an unnecessary test. It’s so important to view this issue from all perspectives. We are so quick to sue for malpractice for things like respect for autonomy, negligence, (among other things), that we have contributed to rising prices in an already expensive healthcare system.
Jain, Manoj. “Even with malpractice insurance, doctors opt for expensive, defensive medicine.” The Washington Post. 31 Aug 2010. Web. 21 Feb 2014.
Regarding the Canterbury vs Spence case, I think the physician should have provided all relevant information including minute risks. As stated previously, though it may seem as if a patient is capable of making an informed decision when provided thorough disclosure, this may not be the case. In the Canterbury vs. Spence case, Spence perhaps did not trust Canterbury’s intuition and believed that providing risky information might turn him around from complying with the surgery. We believe that Spence had the patient’s best interest in mind and this is why certain threatening information was withheld; however, this is the cause for malpractice lawsuits. So, ultimately I do agree with your stance that full disclosure is necessary. On another note, I do not entirely agree with your comparison between public health and informed consent. Specifically, the statement, “It is simply not feasible to adjust these levels or regulations to individual choice, and it is unreasonable to assume that each individual would have the knowledge necessary to make a decision like that” is different than medical informed consent. The government and other agencies monitor water purity and food safety to ensure that it is safe enough to be provided to the public. People’s personal preferences regarding water and food safety should already be in practice, considering the fact that we trust the government and related organizations to provide us with high quality products that are not detrimental to our health in any form. Overall, I do like your main argument I just think that medical ethics are in a different realm than water/food safety.
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