Judicial and legislative Viewpoints on Physician Misestimation of Patient Dysutilities

Abstract

Appellate courts, state legislatures, and ethicists have recently (post-1972) been interested- through the evolving court doctrine of informed consent—in patient-physician joint decision making. Yet these professional groups' approaches differ markedly from that of decision analysis, failing to include an explicit role for patients' rational processing of information in informed consent. In addition, these groups charge that decision analysts are misestimating patient dysutilities. This paper examines three issues: 1) in what sense(s), if any, is decision- analytic work in individualized medical decision making misestimating patient dysutilities, 2) if this misestimation is real, whether it is an example of the normative-descriptive tensions that exist in medical decision making, and 3) in what ways do the relationships between decision-analytic and judicial decision making change when informed consent is viewed in terms of contract law as opposed to tort law. This paper argues that a key link dividing these professional groups is the differing weights given to the "value of information" by decision- analytic vs. non-decision-analytic frameworks. Key words: contract law; hazards; informed consent; legal (court, judicial) decision; malpractice; medical decision making; medical ethics; medical informed consent; medical risk; negligence; professional standards; reasonable person; tort law. (Med Decis Making 1990;10:172-180)

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References

Hershey JC , Baron J. Clinical reasoning and cognitive processes. Med Decis Making . 1987;7:203-11.

Elstein AS , Bordage G. Psychology of clinical reasoning. In: Stone GC, Cohen F, Adler NE, eds. Health Psychology. San Francisco, Jossey-Bass, 1979;333-67.

Elstein AS , Shulman LS , Sprafka SA Medical problem solving: an analysis of clinical reasoning. Cambridge, Harvard University Press, 1978.

Detmer DE , Fryback DG , Gassner K. Heuristics and biases in medical decision making. J Med Educ . 1978;53:682-3.

See, e.g. , McNeil BJ , Pauker SG , Sox HC , Tversky A. On the elicitation of preferences for alternative therapies. N Engl J Med. 1982;306:1259-62;

Abt LE , Stuart IR (edsl: Social psychology and discretionary law. New York: Van Nostrand Reinhold, 1979.

Meisel A. , Kabnick LD Informed consent to medical treatment: an analysis of recent legislation . Univ Pitts Law Rev. 1980;41:407-564.

Canterbury v. Spence, F.2d 464:772, 1972.

Cobbs v. Grant, Cal 3d 8:229, Cal Rptr 104:505, P2d 502:1, 1972.

10.

Harnish v. Children's Hospital Medical Center, Mass 387:152-155, NE 2d 439:240, 1982.

11.

Barnette v. Potenza, Misc. 2d 79:51; NYS 2d 359:432, 1974.

12.

See, e.g., Hopp v. Lepp, SCR 2:192,1980, and Reibl v. Hughes, SCR 2:880, 1980.

13.

Morgenroth v. Pacific Medical Center, Inc., Cal App 3d 54:521, at p. 534 footnote 7; see also Cal Rptr 126:681, 1976.

14.

McKinney v. Nash, Cal App 3d 120:428-441, Cal Rptr 174:642, 1981.

15.

Precourt v. Frederick, NE 2d 481:1144 (Mass 1985).

16.

Winkjer v. Herr, NW 2d 277:579-588 (ND 1979).

17.

Curran WJ

Informed consent in malpractice cases: a turn toward reality

N Engl J Med. 1986;314:429-31.

18.

LaCaze v. Collier, So.2d 434:1039-1046 (La 1983).

19.

Brahams D. Doctor's duty to inform patients of substantial or special risks when offering treatment. Lancet. 1985;i:528-30.

20.

Sidaway v. Bethlem Royal Hospital Governors and others, All ER 1:643-666, 1985.

21.

Sommerville MA Structuring the issues in informed consent. McGill Law J. 1981;26:740-808.

22.

Ill Ann Stat Ch. 111 1/2, 53.31 (Smith-Hurd 1973); Md Health Code Ann 43 556F (1978).

23.

Cal Welf & Inst Code 14191 (West 1975).

24.

Cal Welf & Inst Code 5325 (West 1978).

25.

Mass Gen Laws Ann ch 123, 23 (West 1978).

26.

Cal Civ Code 7005 (West 1979).

27.

Or Rev Stat 435.305 (1975).

28.

Mont Code Ann 53-21-148 (1979).

29.

Iowa Code Ann 147.137.1 (West Cum Supp 1979).

30.

Louisiana Rev Stat Ann 1299.40A(a) (West Cum Supp 1980).

31.

Ohio Rev Code Ann 2317.54A (Page Supp 1978).

32.

Cal Health & Safety Code 1704.5 (West 1980).

33.

Mass Gen Laws Ann ch 111, 70E (West 1979).

34.

Calif Admin Code title 9 , subchapter 4, article 5.5, 851, 1980; see also court rulings on tardive dyskinesia and informed consent, e.g., Rennie v. Klein, F Supp 476:1294 (D. NJ 1979), pp.1309-1310.

35.

Tietz GF Informed consent in the prescription drug context: the special case. Wash Law Rev. 1986;61:367-417.

36.

Roth LH

Is it best to obtain informed consent from schizophrenic patients about the possible risk of drug treatment, for example, tardive dyskinesia, before initiating treatment or at a later date?

J Clin Psychopharm . 1983;3:207-8.

37.

Faden RR , Beauchamp TL A history and theory of infoi-med consent. New York, Oxford University Press, 1986.

38.

President Commission for the Study of Ethical Problems in Medicine and Biomedical Research. Making health care decisions : the ethical and legal implications of informed consent in the patient-practitioner relationship. Washington, DC : U.S. Government Printing Office. 1982;1:29-35.

39.

Epstein RA Medical malpractice: the case for contract. Am Bar Found Res J. 1976;87-149.

40.

Green JA Minimizing malpractice risks by role clarification: the confusing transition from tort to contract. Ann Intern Med. 1988 ;109:234-41.

41.

Kahneman D. , Tversky A. Prospect theory: an analysis of decision under risk. Econometrica. 1979;47:263-91;

42.

Tversky A. , Kahneman D. The framing of decisions and psychology of choice. Science . 1981;211:453-8;

43.

Kahneman D. , Tversky A. Choices, values, and frames. Am Psychologist. 1984;39:341-50.

44.

Sutherland HJ , Llewellyn-Thomas HA , Lockwood G., et al.

Why do patients see, information (abstr)

Med Decis Making. 1987;7289.

45.

Pelligrino ED , Thomasma DC For the patient's good: the restoration of beneficence in health care. New York, Oxford University Press, 1988.

46.

Pauker SP , Pauker SG The amniocentesis decision: ten years of decision analytic experience. In: Evers-Keibooms G, Cassiman JJ, Vandenbeghe H, et al., eds. Genetic risk, risk perception, and decision making, New York , Alan R. Liss, 1987;151-69.

47.

Appelbaum PS , Lidz CW , Meisel A. Informed consent: legal theory and clinical practice. New York, Oxford University Press, 1987.

48.

Shmerling RH , Bedell SE , Lilienfeld A. , Delbanco TL Discussing cardiopulmonary resuscitation: a study of elderly outpatients. J Gen Intern Med. 1988;3:317-21.

49.

Sox HC , Blatt MA , Higgins MC , Marton KI Medical decision making Boston, Butterworths, 1988.

50.

Fischhoff B. Debiasing. In: Kahneman D, Slovic P, Tversky A, eds. Judgment under uncertainty: heuristics and biases. Cambridge, Cambridge University Press, 1982;422-44.

51.