Alert
Bloom & Buell's

WHO KNOWS BEST?

That old gem of traditional wisdom that "Doctor knows best", once widely accepted, especially by doctors, has recently suffered another mortal blow.

Now, says a Massachusetts court, a doctor may no longer decide on a treatment without telling the patient what else he could do, including nothing, and apparently it is the patient's decision what treatment will be administered or what procedure will be used.

If the Massachusetts Appeals Court decision is upheld -- the Supreme Judicial Court has agreed to look at it -- it is conceivable that a doctor may be expected to ask a skier with a broken leg whether he should set it or give him massive doses of pain killer so he can finish his skiing weekend and get his money's worth.

We have all heard the famous story of how Al Capone died of syphilis because he was afraid of the needle and begged his doctor to do something else, anything but that dreaded needle. The doc obliged because in his heyday Al Capone's wishes carried almost as much weight as the opinions of the appeals court. You can say this about old Alphonse: he took his medicine and never sued for malpractice.

The Appeals Court did not deal with the question of what to do when the patient is comatose and won't live to meddle in the treatment unless something is done that the doctor deems proper. Informed Consent, the doctrine that no patient may be treated without agreeing to the treatment after having been told of its risks, has been with us since 1982, but this new decision goes a step further in that it requires a physician to also tell the patient of alternatives available, and what the risks and benefits of each alternative are, including the pros and cons of doing nothing.

In the recent ruling, the Massachusetts Appeals Court held that two obstetricians should not have decided to wait for spontaneous labor in the case of a woman about to give birth without first telling her of the risks and other possible courses of action, and then letting her choose among those other approaches.

The mother's attorney had argued at trial that she had not been informed well enough to give informed consent, that she should have been apprised of what were the other choices, including having labor induced.

At least one previous ruling had held that a "physician must disclose to his patient only such information as is customarily disclosed by physicians in similar circumstances." Now the Appeals Court has disagreed, saying that "the customary practice standard overlooks the purpose of requiring disclosure, which is protection of the patient's right to decide for himself."