From the Guidelines
A doctor can indeed be held liable for failing to inform a patient about a nonunion after foot surgery, as this omission violates the principle of informed consent and the duty to disclose significant medical information. This situation is akin to other medical errors or negligence cases, where the outcome alone does not determine liability, as noted in the Institute of Medicine’s report To Err Is Human: Building a Safer Health System 1. The key factor is whether the doctor's actions or omissions deviated from the standard of care, causing harm to the patient. In the context of a nonunion after foot surgery, the standard of care includes informing the patient about the complication, its implications, and available treatment options.
When considering liability, several factors come into play, including:
- The jurisdiction's laws regarding informed consent and medical negligence
- Whether the failure to disclose the nonunion caused the patient harm, such as prolonged recovery, additional surgeries, or increased disability
- Whether earlier disclosure and intervention could have led to a better outcome for the patient
The legal framework surrounding medical negligence emphasizes that a negative outcome by itself is not sufficient to establish negligence; there must be a breach of the standard of care that directly results in patient harm 1. Therefore, in cases where a nonunion occurs and the patient is not adequately informed, the focus would be on whether the lack of disclosure constituted a breach of the standard of care and whether this breach led to harm.
Given the importance of patient autonomy and informed decision-making in healthcare, the duty to inform patients about significant developments in their care, including complications like nonunion after foot surgery, is paramount. This principle is fundamental to the ethical practice of medicine and is supported by legal standards that prioritize patient rights and well-being.
From the Research
Liability for Failing to Inform a Patient about Nonunion after Foot Surgery
- A doctor's liability for failing to inform a patient about a nonunion after foot surgery can be assessed based on the principles of informed consent and disclosure in the physician-patient relationship 2, 3.
- The doctrine of informed consent requires physicians to disclose to patients the nature of a proposed course of treatment, material risks and benefits, as well as reasonably available alternatives, in obtaining consent to treatment 2.
- Recent judicial and legislative developments in the United States suggest that disclosure obligations of physicians are continuing to evolve, and physicians should be aware of these developments to avoid potential legal accountability 2.
- The moral basis of the physician's duties of disclosure can be justified indirectly from an argument in Kant's political philosophy, which argues that pre-legal rights to freedom are the source of a duty to form a state, and the state has the authority to conclusively determine what counts as "consent" in various kinds of transactions 3.
Nonunion Management and Disclosure
- Nonunion management is a complex issue, and various treatment options are available, including surgical and non-invasive methods 4, 5, 6.
- The literature suggests that healing rates between 80 and 100 percent can be achieved with commonly utilized surgical procedures, such as plating with bone graft for long bones 6.
- However, the requirement of surgery creates a large socioeconomic burden, and non-operative treatment options, such as bone growth stimulators (BGS), may be a beneficial option prior to surgical intervention 6.
- Physicians should be aware of the various treatment options available for nonunion management and disclose this information to patients to ensure informed consent 2, 3.