Does Informed Consent Trump Standard Of Care?
- Allen Jacobs DPM FACFAS
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I would like to raise the following question: Can something be legal but not ethical?
Informed consent is a powerful tool serving to protect clinicians from patients who claim they were not informed about their treatment. My question is whether true informed consent allows patient and clinician to bypass recognized standards of care for the patient.
Let me proceed with a recent example. A middle-aged woman sprained her right ankle and was on crutches for the treatment of this problem. Shifting her weight to the opposite foot, she developed heel pain in her left foot. Her primary care physician instructed her to ice her heel, take a nonsteroidal anti-inflammatory drug (NSAID), roll her foot on a bottle and see a podiatrist.
Several weeks later, her podiatrist evaluated her. She received an injection, low Dye strapping and was scheduled for surgery. Eight days later, she underwent an endoscopic plantar fasciotomy and “heel spur excision.” She developed rather serious complications from this surgery and subsequently required five revision surgeries. She has not returned to work since.
She sued for a lack of conservative care. The defense was simple: she signed a consent form. She was informed that non-operative care was an option. She agreed to surgery. She allegedly did so after being informed that non-operative care was an option but she waived such treatment. She therefore underwent surgery.
It is well known by the readers that plantar fasciitis is typically treated by non-operative care.
Absent compelling reasons to do so, my question is whether a patient becomes an acceptable surgical candidate if she or he is properly informed of and waives the option of non-operative care for such a condition. Does informed consent relieve the duty to provide standard of care treatment?