Medical Records, Patient Consent, and Information Management

Medical Records, Patient Consent, and Information Management

Medical Records, Patient Consent, and Information Management: Informed Consent in

Louisiana – Lugenbuhl v. Dowling

Legal citation elements: location, court, defendant, plaintiff
The case involves the action a patient took against a physician for the damages he
allegedly caused for failing to use a surgical mesh as the patient had requested when treating an
incisional hernia. The plaintiff had consulted John Dowling, a doctor and general surgeon, to
repair a cardiac incisional hernia. The plaintiff’s medical history showed two types of hernias.
Previously the plaintiff had sought repairs from other surgeons unsuccessfully. The plaintiff has
preferred a mesh due to previous experience and had signed an informed consent (Lugenbuhl v.
Dowling, 1997).
The plaintiff suffered other injuries and had to undergo further medical treatment. The
plaintiff filed against Dr. Dowling for medical malpractice and insufficient informed consent. He
claimed that the doctor’s denial to use a mesh when repairing the incisional hernia (1987) was
the cause of subsequent herniation (1988), which required further surgery. The jury’s verdict was
in plaintiff’s favor and he was to be paid 300,000 dollars. After the interrogations, it was
established that Dr. Dowling was accountable for damages and this was founded on medical
malpractice. Moreover, he had not obtained informed consent. After the defendant and plaintiff

MEDICAL RECORDS, PATIENT CONSENT, AND INFORMATION MANAGEMENT 3
were through presenting their evidence, the trial judge gave a directed verdict that favored the
doctor in regard to the medical malpractice claim. However, he reserved the claim of informed
consent for the jury to determine. The court of appeals order was that the issues be presented to
the jury.

Informed consent doctrine- importance and meaning

The simplest rationale behind an informed consent is that the patient’s welfare and health
are protected. Patients are also protected from the practitioners’ desires to promote their careers
and science. Patients are guarded from the practitioners’ overconfident but often paternalistic,
incorrect judgments (Lugenbuhl v. Dowling, 1997). The second reason why informed consent is
important is that it promotes autonomy. There is personal autonomy where the patient has self-
rule and makes decisions that are free from others’ interference and particular limitations such as
insufficient comprehension that hinders meaningful choice. This promotes a good life. Third,
patients are prevented from abusive conduct. An informed consent is a bulwark against
deontological offenses including exploitation, coercion, deceit, and assault (Temple Health,
2007).
An informed consent promotes societal trust in medical institutions and caretakers. This
trust ensures that patients abide by medical advice, continue participating in medical research,
and fill organ donor cards. Considering that the informed consent violation might jeopardize that
trust, it has to be avoided at all costs. Hence, an informed consent is vital in both low-impact as
well as low-risk interventions. It addresses the unfairness of lying to patients outrightly even in
cases where there is beneficial placebo impacts (Temple Health, 2007). Another significance of
an informed consent is promoting self-ownership. Patients possess proprietary rights over their
bodies. Usually, when a patient gives consent, the supposed proprietary prohibition on direct

MEDICAL RECORDS, PATIENT CONSENT, AND INFORMATION MANAGEMENT 4
impact and access is removed. This explains better why patients have to grant their permission
even when the medical interventions are clearly beneficial, low-impact, safe, and need no agency
(Thornton, 2000). The non-domination aspect comes in as no person should be under another
person’s arbitrary control. An informed consent assists in preventing this arbitrary control. The
self-control of patients needs unique protection, and this is offered by informed consent. Finally,
an informed consent protects the personal integrity sense in patients (Lugenbuhl v. Dowling,
1997).

Why the doctrine is there and implications of its absence

The presence of the doctrine means that healthcare practitioners have restrictions when
offering care to patients. For instance, a practitioner cannot perform a procedure on a patient who
denies it despite being well informed about it and the impacts of not having it. In addition, an
informed consent means that patients have a say as far as their healthcare is concerned. The
patients’ involvement in the decision-making process means that they are vital components and
can influence the outcome of their healthcare (Temple Health, 2007). Absence of an informed
consent would mean that healthcare professionals can perform any process on a patient anyhow
and without seeing permission from the patient. Even if practitioners did careless mistakes, they
would not held accountable since they have authority over patients’ care. In essence, the
informed consent acts as a regulation where practitioners are required to offer high quality and
ethical care.

Elements for the informed consent to exist under the law

For there to be an informed consent, the practitioner has to provide sufficient information
to the patient to allow him make a decision that is autonomous. However, the investigators
should make sure that the subjects possess sufficient understanding of the information that has

MEDICAL RECORDS, PATIENT CONSENT, AND INFORMATION MANAGEMENT 5
been offered. This means that the consent has to be written in a very lay language that is suitable
to the patients, and the patient’s level of understanding assessed after he reads the consent. After
the patient understands the provided information, he should make a reasonable judgment
depending on the potent impacts of his decision. The patient should make the decision
voluntarily and freely without the subjection to external pressures including undue influence,
manipulation, and coercion (Thornton, 2000).
Negligence and liability- battery, unconsented touching, or breach of a duty
When a breach of contract is categorized as negligence, the deed is normally weighed
against the laid down professional standards. When presented as negligence, the deed is
compared and contrasted with what a practically cautious professional would have taken if faced
with similar or the same circumstances. It means the offered care was never consistent with the
acknowledged standard of care and the injury was outrightly due to the substandard care that was
offered.
In a battery, there is trespass to a person and therefore, no actual damage should be
proved but proof of contact with proper negligence level. The contact for battery has to be
offensive or harmful. Unconsented touching can also be a battery since the person’s personal
dignity is compromised (Lugenbuhl v. Dowling, 1997).

Elements for a patient to give an informed consent

The patient has to be fed with adequate information regarding the treatment or procedure
that is about to be performed on him. In addition to this, he has to show that he has truly
understood everything. Second, the informed consent has to be in written form, and at least in the
most lay language. The patient should be competent enough in making the decision in mention
and the consent has to be on a voluntary basis (Thornton, 2000). Some of the elements that need

MEDICAL RECORDS, PATIENT CONSENT, AND INFORMATION MANAGEMENT 6
to be discussed include the patient’s understanding assessment; the relevant uncertainties,
benefits, and risks of every related alternative; procedure or decision’s nature; reasonable
alternatives for the proposed intervention; and patients’ intervention acceptance.

References

Informed Consent in Louisiana – Lugenbuhl v. Dowling, 701 So.2d 447 (La. 1997), rehearing
denied (Nov 21, 1997) Guide
Temple Health. (2007). A Practical Guide to Informed Consent.

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