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A Procrustean Approach to Informed Consent: The Texas Medical Disclosure Panel

Published online by Cambridge University Press:  27 April 2021

Edward P. Richards III  and
Katharine C. Rathbun
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Extract

One of the central dilemmas in contemporary medical practice is determining how much information a patient needs to make an informed choice of medical care alternatives. On June 1, 1982, Texas began an experiment that requires specific information to be given to patients about to undergo selected medical procedures. The objective of this uniform disclosure is to reduce the threat of medical malpractice lawsuits based on a failure of informed consent. While this is of benefit to physicians, it is unclear whether patients’ needs for information, like the unfortunate guests of Procrustus, will be cut and stretched to fit an inflexible standard. This article reviews the antecedents of this approach to informed consent, the legal and philosophical problems involved in uniform disclosure standards, and the practical problems that uniform disclosure standards pose for health care providers.

Type
Article
Information
Law, Medicine and Healthcare , Volume 10 , Issue 5 , September 1982 , pp. 158 - 164
Copyright
Copyright © 1982 American Society of Law, Medicine & Ethics

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References

6 Tex. Reg. 4669 (Dec. 15, 1981).Google Scholar
Tex. Rev. Civ. Stat. Ann. 4590(i) (1977) [hereinafter referred to as the Act].Google Scholar
The Act, §6.03 (1981).Google Scholar
The following is a fairly complete overview of the Texas informed consent cases: Hood v. Phillips, 554 S.W.2d 160 (Tex. 1977); Jacobs v. Theimer, 519 S.W.2d 846 (Tex. 1975); Hartfiel v. Owen, 618 S. W.2d 902 (Tex. Civ. App. 1981); Sherrill v. McBride, 603 S.W.2d 365 (Tex. Civ. App. 1980); Forney v. Memorial Hosp., 543 S.W.2d 705 (Tex. Civ. App. 1976); Gaut v. Quast, 505 S.W.2d 367 (Tex. Civ. App. 1974); Louis v. Parchman, 493 S.W.2d 310 (Tex. Civ. App. 1973); Ross v. Sher, 483 S.W.2d 297 (Tex. Civ. App. 1972); Webb v. Jorns, 473 S.W.2d 328 (Tex. Civ. App. 1971): Goodnight v. Phillips, 458 S.W.2d 196 (Tex. Civ. App. 1970); Martisek v. Ainsworth, 459 S.W.2d 679 (Tex. Civ. App. 1970); Stinnett v. Price, 446 S.W.2d 893 (Tex. Civ. App. 1969); Weiser v. Hampton, 445 S.W.2d 224 (Tex. Civ. App. 1969); Rea v. Gaulke, 442 S.W.2d 826 (Tex. Civ. App. 1969); Gravis v. Physicians & Surgeons Hosp., 415 S.W.2d 674 (Tex. Civ. App. 1967); Jeffcoat v. Phillips, 417 S.W.2d 903 (Tex. Civ. App. 1967); Anderson v. Hooker, 420 S.W.2d 235 (Tex. Civ. App. 1967).Google Scholar
412 S.W.2d 299, 301 (Tex. 1967) [hereinafter referred to as Wilson].Google Scholar
Richards, E. Silvers, A., Risk Management Theory: Reducing Liability In Corporate and Medical Environments, Houston Law Review 19: 251, 267(1982).Google Scholar
The Act, §1.02(b)(1).Google Scholar
Id. §1.02(a)(6) & (11).Google Scholar
“Authoritative data clearly indicates that there was not in 1977 and there is not now a ‘medical malpractice liability crisis’ with respect to dentists, nurses, podiatrists, and nursing homes, pharmacists, physicians and hospitals” [citations omitted]. Witherspoon, J., Constitutionality of the Texas Statute Limiting Liability for Medical Malpractice, Texas Tech. Law Review 10:419, 445 (1979) [hereinafter referred to as Witherspoon].Google Scholar
The Act, §2.20 (superseded by the Medical Practice Act), Tex. Rev. Civ. Stat. Ann. 4495b (1981).Google Scholar
Id. at §2.03(a) (superseded by the Medical Practice Act).Google Scholar
Id. at §2.08(a) (superseded by the Medical Practice Act).Google Scholar
Id. at §2.09 (superseded by the Medical Practice Act).Google Scholar
Id. at §2.11-2.15 (superseded by the Medical Practice Act).Google Scholar
Id. at §3 (superseded by the Medical Practice Act).Google Scholar
Id. at §4.01(a).Google Scholar
Id. at §4.01(d).Google Scholar
Id. at §5.01.Google Scholar
Id. at §7.01.Google Scholar
Id. at §8.01.Google Scholar
Id. at §10.01.Google Scholar
Id. at §§11.02(a) & 11.04.Google Scholar
Id. at §12.01(a).Google Scholar
Witherspoon, , supra note 9, at 424.Google Scholar
The Act, §6.02.Google Scholar
Riskin, L., Informed Consent: Looking for the Action, University of Illinois Law Forum 4:580 (1975).Google Scholar
The Act, §6.02.Google Scholar
Richards, E. Rathbun, K., The Law of Patient's Rights in Texas, Texas Bar Journal 44:1059 (1981).Google Scholar
Middleton v. Texas Power and Light Co., 185 S.W. 556 (Tex. 1916).Google Scholar
Witherspoon, , supra note 9, at 424.Google Scholar
The Act, §6.02.Google Scholar
Wilson, supra note 5, at 302.Google Scholar
Canterbury v. Spence, 464 F.2d 772, 792 (D.C. Cir.), cert. denied, 409 U.S. 1064 (1972); Trichter, J. Lewis, P., Informed Consent: The Three Tests and a Modest Proposal for the Reality of the Patient as an Individual, Southern Texas Law Journal 21 (2): 155, 156 (1980).Google Scholar
The Act, §6.07(b).Google Scholar
Id. at §6.03(a).Google Scholar
Id. at §6.04(b).Google Scholar
6 Tex. Reg. 4679 (Dec. 15, 1981).Google Scholar
The Act, §§6.07(a)(1) & (2).Google Scholar
6 Tex. Reg. 4670.Google Scholar
Id. at 4672.Google Scholar
Id. at 4680.Google Scholar
Id. at 4676.Google Scholar
Id.Google Scholar
Witherspoon, , supra note 9, at 424.Google Scholar
Letter Advisory Opinion, Texas Attorney General, No. 135 (1977); Elliot, F. The, Impact of the Texas Medical Liability and Insurance Improvement Act on Informed Consent Recovery in Medical Malpractice Litigation, Texas Tech. Law Review 10:381, 384 (1979) [hereinafter referred to as Elliott].Google Scholar
Letter Advisory Opinion, supra note 46.Google Scholar
The Act, §§6.07(a)(1) & (2).Google Scholar
Since presumptions are rebuttable unless otherwise modified, the term presumption will be used interchangeably with the term rebuttable presumption. See generally, McCormick's Handbook of the Law of Evidence (Cleary, E., ed.) (West, St. Paul) (2nd ed., 1972) at 811–25 [hereinafter cited as McCormick, ].Google Scholar
Ray, R., Texas Practice, Vol. 1 (3rd ed. 1980) at 76.Google Scholar
“[L]ike bats of the law flitting in the twilight, but disappearing in the sunshine of actual facts.” McCormick, , supra note 49, at 821.Google Scholar
The Act, §6.07(a)(1).Google Scholar
Id. at §6.07(a)(2).Google Scholar
Id.Google Scholar
Katz, J., Informed Consent—A Fairy Tale? Law's Vision, University of Pittsburgh Law Review 39:137, 167 (1977).Google Scholar
See, e.g., Griswold v. Connecticut, 381 U.S. 479 (1965); Cal. Bus. & Prof. Code §§2234, 2250, 2257, and 2258 (West 1980).Google Scholar
Miesel, A., The Exceptions to the Informed Consent Doctrine: Striking a Balance Between Competing Values in Medical Decision Making, Wisconsin Law Review 1979:413, 448; Weigel, C., Texas Law and Emergency Medicine, South Texas Law Review 15:133, 153 (1974).Google Scholar
See, e.g., Lane v. Candura, 376 N.E.2d 1232 (Mass. App. 1978).Google Scholar
The Texas Act abolishes the duty to inform the patient of the risks of sterilization, while the California Act defines the failure to give the patient this information as “unprofessional conduct,” which can cost a physician his or her medical license; Cal. Bus. & Prof. Code §§2234, 2250, 2257, 2258 (West 1980).Google Scholar
The Act, §6.07(a)(1).Google Scholar
For the classic statement of this position, see Smith, H., Antecedent Grounds of Liability in the Practice of Surgery, Rocky Mountain Law Review 14: 233, 249 (1942). See also Smith, H., Therapeutic Privilege to Withhold Specific Diagnosis from Patient Sick With Serious or Fatal Illness, Tennessee Law Review 19:349 (1946); Lund, , The Doctor, the Patient and the Truth, Tennessee Law Review 19:344 (1946).Google Scholar
Woods v. Brumlop, 377 P.2d 520 (N.M. 1962).Google Scholar
See, e.g., Nishi v. Hartwell, 473 P.2d 116 (Haw. 1970).Google Scholar
Ferrara v. Galluchio, 152 N.E.2d 249 (N.Y. 1958).Google Scholar
Truman v. Thomas, 611 P.2d 902 (Cal. 1980).Google Scholar
“A physician who misleads a patient by not only failing to give a warning of reasonable and recognized risks inherent in a treatment after which the patient would have refused the treatment, but by affirmatively assuring her that there are no risks, knowing such statement to be untrue, is liable for the harmful consequences of the treatment.” Woods v. Brumlop, 377 P.2d 520, 525 (N.M. 1962).Google Scholar
Tex. Rev. Civ. Stat. Ann. 4495b (1981).Google Scholar
The Act, §1.03(a)(2)-(8).Google Scholar
Id. at §6.05.Google Scholar
Id. at §§6.02 & 6.07(a).Google Scholar
Taub, S., Cancer and the Law of Informed Consent, Law, Medicine & Health Care 10 (1): 61, 62 (April 1982).Google ScholarPubMed
Cassileth, B. et al, Information and Participation Preferences Among Cancer Patients, Annals of Internal Medicine 92:832, 835 (1980); Greer, S. et al, Psychological Response to Breast Cancer: Effect on Outcome, Lancet 2(8146): 785 (October 13, 1979); Holden, C., Cancer and the Mind: How Are They Connected? Science 200: 1363 (1978); Mind Cancer, Lancet 1(8118): 706 (March 31, 1979).Google ScholarPubMed
Southwick, A., The Law of Hospital and Health Care Administration (Health Administration Press, Ann Arbor) (1978) at 228.Google Scholar
Cal. Health & Safety Code, §§1704.5, 1708.5 (West 1980); Cal. Welf. & Inst. Code §14191 (West 1975).Google Scholar
California Medical Association v. Lackner, 177 Cal. Rptr. 188 (Cal. App. 1981); see also Brown v. Stewart, 181 Cal. Rptr. 112 (Cal. App. 1982).Google Scholar
California Medical Association v. Lackner, supra note 75, at 190.Google Scholar
Contrast this with the allowable limitations in Planned Parenthood of Central Missouri v. Danforth, 428 U.S. 52, 55 (1976).Google Scholar
Tex. Const. Art. 1, Sec. 13.Google Scholar
Annas, G. Glantz, L. Katz, B., In formed Consent to Human Experimentation: The Subject's Dilemma (Ballinger, Cambridge, Ma.) (1977) at 39.Google Scholar
Griswold v. Connecticut, 381 U.S. 479 (1965).Google Scholar
Annas, G., Avoiding Malpractice Suits through the Use of Informed Consent, Legal Medicine Annual 9: 219 (1977): “There is probably more misinformation and misunderstanding in the medical community concerning the doctrine of informed consent than any other legal construct.” See also Katz, J., Informed Consent—A Fairy Tale? Law's Vision, University of Pittsburgh Law Review 39: 580 (1977).Google Scholar
Schartz, W.B. Komesar, N.K., Doctors, Damages, and Deterrence, New England Journal of Medicine 298(23): 1282 (1978).Google Scholar
Richards, E. Silvers, A., Risk Management Theory: Reducing Liability in Corporate and Medical Environments, Houston Law Review 19: 251, 267 (1982). This area was pioneered by Louis Brown, who has written extensively on the problems of preventive law. See Brown, L., Preventive Law (Prentice-Hall, Englewood Cliffs, N.J.) (1950); Brown, L., Preventive Law and Public Relations: Improving the Legal Health of America, American Bar Association Journal 39(6): 556 (1953).Google Scholar
See Karp v. Cooley, 493 F.2d 408 (5th Cir. 1974).Google Scholar