Abstract
This chapter continues the discussion of informed consent. Although all of the principles addressed in the preceding chapter apply to surgery, surgery deserves its own chapter because of the large number of surgical procedures performed, and because surgery has such a dramatic impact on the patient, for better or worse. There are approximately thirty-five million surgical procedures done annually in the United States, about one surgical procedure for every seven people. The likelihood of any particular person undergoing a surgical procedure in any year, however, is less than this (probably about one in ten) because some people have multiple operations. Surgery accounts for most hospital admissions, more than half of all health care expenditures, and more than half of all malpractice allegations and lawsuits. Because the indications for surgery are often controversial, and usually involve questions of preferred lifestyle, this is an area in which an informed patient can be his or her own most important advocate. As one surgeon has warned, “Remember this about surgery: There are risks. There are benefits. There are choices. There are alternatives. It is your body. It is your life. The final decision is yours.” The “four laws of medicine” for physicians are also worth recounting: 1. If it’s working, keep doing it. 2. If it’s not working, stop doing it. 3. If you don’t know what to do, don’t do anything. 4. Never call a surgeon. (At least, never call a surgeon unless you want an operation.)
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Notes
G. Crile, Surgery (New York: Delacorte Press, 1978), at xvi.
M. Konner, Becoming a Doctor (New York: Penguin Books, 1988), at 21.
Rutkow, General Surgical Operations in the United States, 121 Arch. Surg. 1145(1986).
See generally Boston Women’s Health Book Collective, The New Our Bodies, Ourselves (New York: Simon & Schuster, 1984).
Graboys et al., Results of a Second-Opinion Program for Coronary Artery Bypass Graft Surgery, 258 JAMA 1611(1987); and see generally Friedman, “Second-Opinion Programs Come into Their Own,” Hospitals, July 16, 1984, at 105.
E.g., Clarke, A Comparison of Decision Analysis and Second Opinion for Surgical Decisions, 120 Arch. Surg. 844 (1985).
Supra note 1, at xiii.
E.g., in Consumer Checkbook, Consumers’ Guide to Hospitals (Washington, DC: Washington Consumers’ Checkbook, 1988). (Send $8 for a copy of this book to Washington Consumer’s Checkbook, 806 15th St. NW, Suite 925, Washington, DC 20005 (202) 347-9612. But see Tolchin, “Data on Hospital Mortality Rates Are Challenged,” New York Times, July 11, 1988, at A13; and Dubois et al., Hospital Inpatient Mortality: Is It a Predictor of Quality? 317 New Eng. J. Med. 1674 (1987).
Dabice & Cordes, “Informed Consent Heralds Change in Breast Treatment,” Medical News, Nov. 11, 1985, at 1, 4.
J. Katz, The Silent World of Doctor and Patient (New Haven, Conn.: Yale U. Press, 1984), at 183–84. A US News and World Report cover story on breast cancer concluded: “The fact is that since so much of breast cancer treatment is experimental, no one knows the bottom line of what benefits whom. Three well-qualified doctors may suggest three completely different treatment plans. So no woman diagnosed with breast cancer can afford to let her doctor do all the deciding.” “How to Beat Breast Cancer,” July 11, 1988, at 52, 56. The good news is that modern cancer specialists “welcome a woman’s active participation in treatment decisions” (Siegel, “Deciding Factors: New Options in Breast Cancer Therapy Can Save a Woman’s Life and Her Sense of Self,” Self, Feb. 1989, at 127). For information on cancer treatment and research call the National Cancer Institute (NCI) (800-4CANCER).
The entire poem appears in J. Mukand, ed., Sutured Words: Contemporary Poems about Medicine (Brookline, Mass.: Aviva Press, 1987), at 124.
See, e.g., Mayer & Patterson, How Is Cancer Treatment Chosen? 318 New Eng. J. Med. 636 (1988).
See, e.g., Rensberger, “The Touchy Ethical Issue of Trainee Surgeons Operating without Consent of Patients,” New York Times, Feb. 6, 1978, at B12.
Johnson v. McMurray, 461 So. 2d 775 (Ala. 1984).
Pugsley v. Privette, 220 Va. 892, 263 S.E.2d 69 (Va. 1980).
For information on surgeons who will honor a patient’s request not to do blood transfusions, call 1-800-NO-BLOOD. On the question of whether the blood of surgeons should be screened to see if they are infected with HIV, see Gostin, HlV-Infected Physicians and the Practice of Seriously Invasive Procedures, 19 Hastings Center Report 32 (Jan. 1989).
Barnett v. Bachrach, 34 A.2d 626 (Mun. Ct. App. DC 1943).
Kennedy v. Parrott, 243 N.C. 355, 362, 90 S.E.2d 754, 759 (1956).
Wells v. Van Non, 100 Ohio St. 101, 125 N.E. 910 (1919).
Mohr v. Williams, 95 Minn. 261, 104 N.W. 12 (1905).
Mass. Gen. L. ch. 112, sec. 12(F).
Bishop v. Shurly, 237 Mich. 76, 211 N.W. 75 (1926).
Gulf& S.l.R. Co. v. Sullivan, 155 Miss. 1, 119 So. 501 (1928).
Younts v. St. Francis Hospital, 205 Kan. 292, 469 P.2d 330 (1970).}
State v. Perricone, 37 N.J. 463, 181 A.2d 751(1962).
In re Sampson, 65 Misc. 2d 658, 317 N.Y.S.2d 641(1970), affd 29 N.Y.2d 900, 278 N.E.2d 918 (1972).}
In re Seiferth, 309 N.Y. 80, 127 N.E.2d 820 (1955).
Simpson, Contracts, sec. 105.
In re Smith, 16 Md. App. 209, 225, 295 A.2d 238, 246 (1972).
P. Starr, The Social Transformation of American Medicine (New York: Basic Books, 1982), at 158.
Robertson, Young Children in Hospitals (New York: Basic Books: 1958); and see Diesenhouse, “Suffering of Children Is Eased as Hospitals Change to Keep Families Near,” New York Times, Dec. 15,1988, at B22.
For further information write Barbara Popper, Children in Hospitals, 31 Wilshire Park, Needham, Mass. 02191 (617) 482-2915.
B. Siegel, Love, Medicine and Miracles (New York: Harper & Row, 1986), at 173–74.
Supra note 1.
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© 1992 George J. Annas and the American Civil Liberties Union
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Annas, G.J. (1992). Surgery. In: The Rights of Patients. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-4612-0397-1_7
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