Forensic Psychiatry Abpn Exam

Front 1

Natanson v. Kline

Not a Landmark Case

Back 1

Informed Consent
Kansas Supreme Court – 1960
Irma Natanson had a radical mastectomy and cobalt treatments in 1955 – She suffered severe radiation burns and sued Dr. Kline for negligence and lack of information prior to her consent
Jury returned verdict in favor of the defendants – The trial court refused to instruct the jury on the doctor’s duty to inform the patient of risks
In order to be held to have given an intelligent consent to a proposed treatment, the physician must have to disclose those consequences of treatment which a reasonable medical practitioner would under the same or similar circumstances
First court requirement for informed consent

Front 2

Canterbury v. Spence

Back 2

Informed Consent
US Court of Appeals, DC Circuit – 1972
Jerry Canterbury (19) had a laminectomy by Dr. Spence – Mother was informed of the operation and told it was ‘no more dangerous than any operation’
Patient became paraplegic and sued on the basis of inadequate information and negligent surgery and nursing care – Dr. Spence argued that communication of the possible risks was not good practice – Trial court found for the defendants
Appellate Court reversed: “Scope of information must be determined by the patient’s need” – The standard should be set by law rather than physicians
Objective test of liability for the standard of informed consent – what the average person would want to know before giving consent to treatment
A materiality of the information standard – A standard as to extent of disclosure by a physician is not subjective to either physician or patient, but remains objective with due regard for patient’s informational needs, with subtle leeway for the physician’s situation (emergency, therapeutic exception, incompetence, and waiver)
The most important point of this ruling resulted in the avoidance of the subjectivity of the “reasonable medical practitioner” standard by setting a new standard that can be easily ascertained by the trier of fact without the intermediacy of an expert witness

Front 3

Kaimowitz v. Michigan Department of Mental Health

Back 3

Informed Consent
Michigan Circuit Court, Wayne County – 1973
Lewis Smith committed in 1955 as a criminal sexual psychopath – in 1972, he was transferred for psychosurgery to which he and his parents had consented
Court held that neither a person involuntarily detained, nor their guardian, can give legally adequate consent to an experimental procedure where the danger is high and the risks incapable of assessment
Involuntarily confined mental patients live in an inherently coercive institutional environment
The surgery, which was an experimental amygdaloidal psychosurgery, would disrupt memory – case was also argued on a violation of First Amendment rights (the right to generate new ideas)

Front 4

Truman v. Thomas

Back 4

Informed Consent
California Supreme Court – 1980
Children of Rena Truman brought malpractice case against Dr. Thomas because he failed to do Pap test over a six year period, and patient died of cervical cancer in 1970 – Dr. Thomas indicated he suggested Pap but she declined – Trial court found him not negligent
Supreme Court remanded because trial court failed to charge jury with review of physician duty to disclose all material information to the patient
Whether procedure involves treatment or diagnostic test, the patient must be apprised not only of the risks inherent in the procedure involved, but also the risks of the decision not to undergo treatment – and the probability of successful outcome of treatment (an expansion of Canterbury v. Spence)

Front 5

Cruzan v. Director, Missouri Department of Health

Back 5

Right to Die / Right to Refuse Treatment / Informed Consent
USSC – 1990
In 1983, Nancy Cruzan was in an MVA with prolonged hypoxia – for 6 years she was in persistent vegetative state
Hospital employees refused to terminate nutrition, but the trial court accepted previous stated desires – state supreme court reversed, ruling that statues favored preservation of life
Supreme Court held that:
- A competent person has the right to refuse unwanted medical treatment
- State had the right to demand clear and convincing proof of a patient’s (competent or incompetent) wishes to withdraw life-sustaining treatment
The question is a balance of state interests against individual interests – in this case the need to demonstrate the accuracy of substituted judgment
This asymmetrical distribution of the risk of error favors the status quo (potential correction of a wrong decision versus an irreversible termination of life)

Front 6

Vacco v. Quill

Back 6

Right to Die
USSC – 1997
Doctors and patients sued the NY Attorney General because ban on assisted suicide violated the Equal Protection clause – Comparison population are patients with terminal illness who refuse life sustaining treatments
District Court disagreed, but Second Circuit Court of Appeals reversed
USSC ruled that New York’s statutory and common law regiment that criminalizes assisted suicide while permitting terminally ill, mentally competent patients to refuse life-sustaining treatment does not violate Equal Protection Clause
Supreme Court held that the ban does not involve suspect classifications or draw distinctions between persons – There is a clear distinction between letting a patient die and making a patient die

Front 7

Washington v. Glucksberg

Back 7

Right to Die
USSC – 1997
Physicians and patients sought an end to a Washington State ban on assisted suicide under 14th amendment due process clause. Federal district Court and Ninth Circuit Court affirmed
The Supreme Court held that The Washington statute that imposed criminal penalty on anyone who knowingly causes or aids another person to attempt suicide does not violate Fourteenth Amendment’s Due Process Clause
Due process clause specifically protects fundamental rights and liberties rooted in tradition – it also requires a careful description of the asserted fundamental liberty interest