Att OPTIONS MUST BE DESCRIBED
\bu nrust full,v inforrn the patient of the risks ancl benefits of each procedure prior to undergoing thc procedure. Thc explanation must be in language that the paticnt understands and include full infbrnation regarding alternative treatments. ‘I’he paticnt cannot make an informcd choice for one treatment if she cloes not latow of the existencc of oth
For example, you inform a patient about the risks iurd benefits of bone marrow transplantation fcrr chronic myelogenous leukemia. You fully inform the patient about the risk of transplantation, including the possibility of deveJoping graft versus host disease. Afier the transplantation the patient develops graft versus host disease, which is hard to control. The patient learns that there is an alternative treatment called imitanib (gleevec), rvhich tloes not includc the r isk of graft versus host disease, but which rvill not cure the lcukemia. The patient files suit against you. What rvill be the most likely outcomc of the suit?
In this case the patient rvill probably win the suit because he was not fully intbrned about the alternatives to the therapics mentioned. The physician has an ethical duty to ir.rfbrm thc patient about all the treirtmcnt options and then allorv thc patient to decidc among thcm. Although the phvsician’s pref-erence of procedure or treatment may differ from what thc patient chooses, the patient has the option to choose therapy that may not be ^rltat the doctor deems is best for hin.
AtL MAJOR ADVERSE EFFECTS MUST BE DESCRIBED
Advcrse effects ancl injury lrorn rnerlical care do not necessarily represent a mistakc or fail urc of therapy. In the case describcd in the previous exantple, the error was not that graft versus host clisease developed. Thc patient was fully informed that this could occur and he chose the bone marrow triursplantation anyway. The error \ras not informing thc patient of an alternatir.e option in treatmcnt. At the same time, a patient could potentially die as an adverse effect of treatment. This is only an ethical and legal problen if the adverse event happcns and the patient was not told that it could have happened. The patient n.ight say, “Doctor, I would never havc taken digoxin if ,you had told me it night cause a rhythm dis turbance or visual problenr” or’“I rvoulcl never have had surgery ifyou had told mc I might nccd a bloocl transfusion.” Thc m.rin point is tt’ rc\pcct 3utonolly. The patieitt must be ir.rforn.red of the therapeutic options, the adverse eff-ects of the procedure, and the harm of not undergoing the procedurc. If thcy have the capacity to understand and thcy choose to do it ar.rvr,vay, they have made an autonomous tlrerapelrtic choice, and therefore, thc patient bears the burclen of any adversc cffect, not the physician.
For example, a man underploes coronary angioplasty. He is inforned that tl.re artery may rupturc and that there is a srnall chance he could bleed to dcath during the surgery to repair thc danaged vessel. He knorvs he could have bypass surgery instead. He understands and chooses the angioplasty. He dies from a ruptured blood vessel. The fanily files suit against you. What will be the n.rost likcly out come?
Although it is unfortunate thal the patient died in this case, there is no liability with regard to informed conscnt or ethical error. 'l’he patielt was intbrmed of his trcatment options anci the possible complications, ancl he chose the treatment.
The patient mlrst undcrstand the risks of a procedure just as a drivcr rrust understand the risks before getting behind the wheel of a car. Why can’t you sLlc a car manufacturer if you die in a car accidcnt? Predominantly because you are an adult with the capacity to ur.rderstand the risks of driving ancl you chose to drive an1.way. Tl.re liccnsing process is an education process that both tries to make you a safe driver, while also properly informing you of the risks of driving. Each time you get in a car, there is i.r.nplied consent that you are choosing the risk of driving. Evcn if you €let into a car accident and arre injured or killecl, the manufacturer has no liability, as long as the car is well ntade, trecause as a compctent adult you chose to put yourself at risk.