by David Pauls, MD FACS
March 29, 2007
LifeNews.com Note: Dr. David Pauls is the president of the Center for Bioethics and Culture.
If you came to me to have your hernia repaired, you would expect me to tell you about the operation, the recovery time and the risks of the operation. If you had questions, I would be expected to answer them in such a way that you would understand what I was saying.
This is taught throughout a doctor’s training and is part of the legal standard for obtaining informed consent. Yet, when the discussion goes from a hernia repair to embryonic stem cell research and cloning, the imperative for clarity vanishes.
Medical school deans who implore their students to relate to patients on the patients’ level suddenly speak to the public using highly technical language, talking over the heads of those listening.
If anything, the scientific community, particularly the medical community, has a fiduciary responsibility to relate in such a way that people can have a basic understanding of the issues.
For those not familiar with the term, a fiduciary is a person placed in a position of trust who is expected to place the interests of the person he or she serves ahead of their own interest. Typically, these are relationships when there is a power imbalance between the two parties.
There are many examples of fiduciary relationships in our society, such as that of a doctor and patient or a lawyer and his or her client. The relationship between a parent and child can also be seen as a fiduciary relationship. What is common among all these relationships is that the person in the position of power must look out for the interests of the other weaker party.
In the doctor-patient relationship, the physician has a duty to relate to his or her patient’s in such a way that the patient has an understanding of what the doctor is proposing. Failure to do this is not only morally wrong, it is legally wrong, violating the basic tenets of informed consent.
Informed consent is not signing a piece of paper. It is a process that occurs between the physician and the patient. The doctor explains the problem as well as the proposals to treat the problem. This includes not only discussing what should be done, but the risks of the treatment as well as alternative treatments.
If I propose to fix your hernia, I not only discuss the operation itself, but also discuss different ways of doing the operation, the risks of the operation as well as the risks of not doing the operation. Not only do I have to discuss this, I also have a duty to make sure you understand what we just talked about. Failure to do so can be grounds for legal action and many times medical malpractice cases include such a claim.
If I fix your hernia but don’t tell you that there can be pain afterwards, then there might be grounds for a claim of lack of informed consent, since pain after hernia repair is one of the more common complications.
The discussion about embryonic research and cloning will affect each of us in some way, shape or form. An attempt to stifle discussion by using obscure technical language does a disservice to the general public who is being asked to ultimately foot the bill.
If you have questions or aren’t clear about the issue, the CBC has resources that can help clarify the issue for you. Feel free to contact us with your questions and thank you for your support.