Science and Law: Culbertson v. Mernitz: What is informed consent?

February 4, 2015

Science and Law

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This next case deals with the idea of informed consent. How much information should a doctor be required to reveal to their patient when discussing a possible medical procedure, medication, or other medical intervention? Culbertson v. Mernitz deals with a surgical procedure, and explains some of the basic tenets of the informed consent doctrine in American law.


Case Background:

  • In March of 1988 Patty Jo Culbertson spoke to Dr. Roland B. Mernitz about uncontrollable vaginal discharge and incontinence. Mernitz determined that she had a mild cystocele (a condition where the bladder bulges into the vagina), cervicitis (inflammation of the cervix), and multiple fibroid tumors of the uterus (typically benign tumors that can grow to an uncomfortable size, necessitating removal).
  • Mernitz recommended the Marshall Marchetti Krantz procedure (MMK), including bladder suspension to pull the bladder into proper position, and cryosurgery on the infected tip of the cervix (freezing the end of the cervix to destroy abnormal tissue).
  • Culbertson chose the MMK and cryosurgery, both of which were performed by Mernitz. However, her cervix adhered to her vaginal wall afterwards, a risk which the doctor did not disclose, since he did not consider it a reasonable risk to disclose, due to its rarity.
  • Culbertson saw another surgeon, who performed a total abdominal hysterectomy (removal of the uterus), bilateral salpingo oophorectomy (removing the ovaries and fallopian tubes) and another MMK to correct the condition.

What issues are being debated?

  • How does the Indiana Supreme Court define informed consent?
  • If doctors are required to meet a ‘standard of care,’ how do we define ‘standard of care’ for this case?
  • What information should doctors be required to disclose to patients?
  • What would a ‘reasonably prudent’ physician typically tell a patient?
  • Can a standard of informed consent be applied to all patients equally?
  • Should the informed consent standard be viewed from the perspective of the patient, or the physician?

How was the law interpreted and applied in this case?

  • A medical review panel determined that failing to disclose the risk of cervical adhesion did not constitute a violation of a physician’s duty to comply with the appropriate standard of care.
  • The court disagreed with the Culbertsons’ view, which claimed that Mernitz was negligent for not informing her of the risks of bleeding, infection, death from anesthesia, and bladder perforation, which did not occur in this instance. This is because it would have allowed patients to sue for a medically unforeseeable injury by claiming that a doctor had not informed them of a foreseeable one that did not occur.
  • However, the court agreed that the case should go to trial, because the court needed to assess the relevancy of the level of risk for cervical adhesion.

Further Analysis

One issue that this case brings up is difference in perspectives between patients and doctors. What some patients might consider relevant risks, a physician would consider immaterial. The U.S. has been shifting towards favoring patients in these cases. What should we demand that our physicians disclose? Should they be required to explain medical alternatives? Should they be required to disclose any financial interests connected to their patients?

Taking this to the extreme, we can understand that there are limits to what a physician should be required to tell a patient. Moving beyond the medical field, consider this situation. What if all stores at shopping malls that offered on-site ear piercings had to also provide a disclaimer that ear piercing can lead to death? The risk is astronomically small compared to the risk involved simply driving to the mall, but it exists nonetheless. It would seem ridiculous to require this for all ear piercings, as it would lead to unnecessary panic, but it illustrates a point – it is difficult to define the line between that which should be disclosed, and that which can be left unsaid.

http://www.leagle.com/decision/19921631591NE2d1040_11593.xml/CULBERTSON%20v.%20MERNITZ

http://www.medicinenet.com/uterine_fibroids/page3.htm#do_untreated_uterine_fibroids_pose_a_risk

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About jslachman381

I'm a Yale graduate who majored in History of Science, Medicine, and Public Health.

View all posts by jslachman381

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