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Ann Thorac Surg 2002;74:1431-1432
© 2002 The Society of Thoracic Surgeons

Ethics in cardiothoracic surgery

Honor the patient’s wishes

David E. Guinn, JD, PhDa*

a International Human Rights Law Institute, DePaul University College of Law, Chicago, Illinois, USA

* Address reprint requests to Dr Guinn, DePaul University College of Law, 8th floor, 25 E Jackson Blvd, Chicago, IL60604-2287, USA.
e-mail: dguinn@depaul.edu

The first 20% of the full text of this article appears below.

This case illustrates how good people adhering to a formalistic approach to informed consent may consciously or unconsciously manipulate and coerce their patients to achieve a desired medical end. Using a series of decision-making opportunities that ostensibly conform to standard ethical practice, Dr Smith succeeds in saving Mr Charles’ life. He does so, however, by betraying the trust and dignity of his patient.

This case is not about whether a Jehovah’s Witness has the right to refuse a blood transfusion. It is about the rights of patients to live their lives according to their own values and beliefs and the duty of health-care providers to respect that right.

Taken individually, Dr Smith’s discussion of treatment and the obtaining of consent on each of the four occasions when it occurred appear reasonable and justified. At a formal level, consent requires that Dr Smith provide all relevant information necessary for Mr Charles to make an informed decision. As the medical expert, Dr Smith needs to assure himself that Mr Charles understands what he has been told. Mr Charles’ refusal of any non–self-donated transfusions in the course of undergoing triple bypass operation obviously presents significant risks of physical harm. Discussing this risk and requiring the patient to execute documents that absolve caregivers from liability arising from this decision provides one way of assuring that Mr Charles truly understands the consequences of his decision.

However, looking at the four discussions collectively suggests a pattern of disagreement and disrespect for Mr Charles and his religious beliefs. There are at least two obvious problems. First, Dr Smith immediately . . . [Full Text of this Article]




This article has been cited by other articles:


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Ann. Thorac. Surg., October 1, 2003; 76(4): 1336 - 1336.
[Full Text] [PDF]


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