Tag Archives: #informedconsent

Fear of the Law

The Canterbury v. Spence case brings our attention to the ethical issues of risk disclosure of a medical procedure. This type of case involves and compares the importance of several pillars of ethics: autonomy, benevolence and malevolence. There seems to be a question that is very difficult to answer, and may differ on a case-to-case basis: Does, “every human being of adult years and sound mind has a right to determine what shall be done with his own body…” (an issue of autonomy) trump a doctor acting in the patient’s best interest and avoiding harm to the patient (benevolence/malevolence)? (https://ereserves.library.emory.edu/reservesViewer.php?reserve=563719) It’s convenient to believe that the legal system keeps people on a moral path and helps people make decisions that are ethically sound and in the best interest of society as a whole. But in some cases, fear of the law may cause more issues than it does good.

Risk of a procedure is not the only type of information that doctors potentially keep from their patients. There is also the issue of disclosing errors that may have occurred during the process of a patient’s care. According to an article in Ghana Medical Journal (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2709172/) doctors often do not tell patients or their families when an error has occurred, whether it be in surgery or anything else related to the patient’s health care. Instead, the doctors and institutions tend to try and cover up these events to avoid legal issues. In this case, the doctors are putting their own well being above that of their patients. According to the report, healthcare errors lead to more deaths than motor vehicle accidents, breast cancer or AIDS in the US. (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2709172/).

Putting your life, or the life of a loved one in the hands of a human, capable of error, is an act of immense trust. The article refers to the doctor-patient relationship as fiduciary; “one who owes to another the duties of good faith, trust, confidence and candour”. This is trusting the doctor to act in best interest of the patient. However, can a doctor do that if he is worried about the consequences of an error? If he puts his own well being before that of the patient’s?

In class, we have talked about the importance of intention in ethics. When it comes to health care and medicine, if someone’s life is at stake, people tend to care less about intention and more about the outcome. If an error results in a patient’s death, the family cares little about the doctor’s intention to do good, the focus is on the error that resulted in death. This is the responsibility and punishment that the doctor must shoulder as a casualty of his daily work.

Here we have two different types of disclosure: risk disclosure before a procedure, and disclosure of any errors after a procedure. For the first, the law helps to encourage doctors to share all possible complications with the patient, to avoid lawsuits should anything go wrong. For the second, the threat of the law dissuades doctors from disclosing human error events that may have occurred. This would lead us to the assumption that doctors’ morals are rooted in fear of the law rather then intrinsic human nature.

However, this is not always the case. Like in the Canterbury v. Spence case, doctors sometimes choose to not share some information that they believe may do more harm then good. They take the risk of the potential lawsuit in their effort to do what they believe is best for the patient. In this case, the doctor is putting the patient’s well being above his own. So which is more important, the patient’s autonomy or the doctor’s duty to do what he feels is best for the patient?



Edwin AK. Non-disclosure of medical errors an egregious violation of ethical principles. Ghana Med J. 2009;43(1):34–9. [PMC free article] [PubMedhttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC2709172/?report=classic

Informed Consent: Opinion Canterbury v Spence https://ereserves.library.emory.edu/reservesViewer.php?reserve=563719 Physicians’ obligations and patients’ rights.


Blame House


People love to watch the heightened drama of the emergency room and hospital from the comfort of their own couch. They do not have to deal with the emotional stress nor feel faint from the physical sight of blood. All they see are attractive, smart doctors treating patients with ease. But this glamorized medical world is far from reality. Seldom to people recognize the moral dilemmas of medical treatment and professionalism depicted in popular medical television shows like House, M.D. and Grey’s Anatomy.

Faculty from the John Hopkins’ Berman Institute of Bioethics analyzed depictions of bioethical issues and professionalism over a full season of Grey’s Anatomy and House, M.D. and found that “the shows were “rife” with ethical dilemmas and actions that often ran afoul of professional codes of conduct” (Nauert). Informed consent was the most frequently witnessed bioethical issue. In the total of 49 cases, 43 percent were cited as “exemplary” consent, meaning that the depictions portrayed a balanced discussion with the patient about possible treatment options, and the remaining cases were classified as “inadequate” (Nauert). Inadequate depictions involved hurried, one-sided discussions and refusal of physicians to answer patient’s questions, sometimes even complete disregard for the informed consent doctrine (Nauert).

Occasionally, dismissal of informed consent seems justified by positive outcomes, as seen in the following clip from Grey’s Anatomy, when an autopsy is conducted on a deceased patient without the family’s consent: https://www.youtube.com/watch?v=0hgNQni0xdw. However, this is how the screenwriters wanted the situation to play out. In the real world, serious repercussions would obviously accompany the doctors’ rash decision.

While television’s impact on us is limited, it still has an influence on our expectations and beliefs about the world around us. It has shaped our perceptions of many careers like law enforcement and forensic science; medicine is no different. A previous study conducted by one of the co-authors of the article, found that more than 80 percent of medical and nursing students watch medical dramas on television (Nauert). What exactly are aspiring doctors learning from these shows? How do various depictions of ethical issues shape their moral perception of every day patient encounters?

As previously mentioned in other blog posts, physicians do not think informed consent is an “integral part of good patient care” (Lidz et al, 303). Perhaps the popular medical dramas are to blame.


Lidz, Charles W., Meisel, Alan, Osterweis, Marian, Holden, Janice L., Marx, John H., Munetz, Mark R. “Barriers to Informed Consent.” Arguing about bioethics. London: Routledge, 2012. 299-307. Print.

Nauert, Rick. “Ethical Failures Found on ‘Grey’s Anatomy’ and ‘House'” LiveScience. TechMedia Network, 30 Mar. 2010. Web. 17 Feb. 2014. http://www.livescience.com/6240-ethical-failures-grey-anatomy-house.html