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The issues of informed consent and patient rights often arise in the treatment of intoxicated patients. The controversy is whether or not an intoxicated patient has the mental capacity to fully understand the benefits and risks associated with the procedure.
The Supreme Court of Rhode Island recently undertook the question of informed consent for an intoxicated patient. The plaintiff was admitted to Rhode Island Hospital following an automobile accident. The plaintiff stated that he had consumed between seven and twelve alcoholic beverages before the accident. The patient treated as a surgical emergency and was seen by three of the hospital's trauma physicians.
The patient underwent a series of diagnostic tests. Blood was drawn, x-rays were taken, and a catheter was inserted to check for blood in his urine. The patient's blood alcohol level was found to be 0.233, or, approximately sixteen alcoholic drinks.
The patient overheard a doctor tell someone to prepare him for an abdominal incision so that a diagnostic lavage could be performed. The patient questioned the doctor as to what would occur, and told the doctor he did not want the procedure performed. The doctor replied that the patient did not know the extent of his injuries due to his condition, and that peritoneal lavage was standard procedure in these situations.
The plaintiff claimed that the doctor did not ask for his consent or the consent of any family members. The plaintiff was strapped to a gurney and given anesthesia. When he regained consciousness, he had a three-inch incision on his stomach.
Rhode Island Hospital attempted to present three expert witnesses. The first would testify that the American College of Surgeons obligated a physician to perform a peritoneal lavage on intoxicated patients who undergo trauma. The second expert would testify on the amount of alcohol in the plaintiff's blood, and its effect on the plaintiff. The third expert would testify that a nonconsensual lavage could be performed given two factors. First, if the accident could have caused internal injuries, and second if the patient could not sense or report symptoms of internal bleeding because his mental status was impaired either by drugs, alcohol or a head injury.
The trial judge disallowed all of the testimony from the three experts for the Rhode Island Hospital on the premise that intoxication does not affect a patient's right to consent to or refuse treatment. The jury found that the hospital committed battery by performing peritoneal lavage without the patient's consent.
The jury awarded the plaintiff $10,000.00 and the hospital appealed. The hospital argued that if the physician granted the patient's wishes, the physician could be liable for malpractice in failing to treat the patient. For example, if this patient had died or suffered serious injury due to undiagnosed internal bleeding, the plaintiff could then argue that emergency treatment should have been rendered due to his lack of ability to make an informed decision.
The Supreme Court of Rhode Island held that a doctor must determine if the patient has sufficient mind to reasonably understand the condition, nature and effect of the treatment and the ability to weigh the risks and benefits associated with pursuing the treatment. Intoxication may impair an otherwise competent patient's consensual ability regarding medical treatment. But, intoxication does not make all patients incapable of giving informed consent. The Supreme Court of Rhode Island found that the affect of intoxication on a patient's ability to consent to medical treatment was a question for the jury. Therefore, judgment for the plaintiff was reversed and a new trial was ordered.
An appellate court in New York reached a similar decision regarding the medical treatment of intoxicated patients. In Oates v. New York Hospital, an intoxicated patient arrived at the emergency room with multiple stab wounds. An exploratory laproscomy was performed against the patient's wishes. Despite its attempts, the hospital was unable to get consent from the patient's family. The hospital believed the patient was in a life-threatening position and that the patient was incapable of making a reasonable decision regarding medical treatment.
The patient sued the hospital for assault, punitive damages and malpractice. Here, the appellate court agreed with the trial court in that an intoxicated patient's ability to make decisions regarding medical treatment was a question of fact for a jury.
Physicians have a duty to disclose medical information that will enable a reasonable patient to make an informed decision regarding his or her medical treatment. In some instances, the patient may not have the mental ability to understand the situation and make a reasonable decision regarding his or her treatment. "Lack of competence to consent to treatment may result from a patient's unconsciousness, the influence of drugs or intoxicants, mental illness, or other permanent or temporary impairment of reasoning power." (Hospital Law Manual, "Consent From Persons Other than the Patient: Incompetents", p. 89).
In emergency situations, the physician may have a duty to proceed with the procedure even if the patient has refused to consent. If the failure to perform the procedure would constitute malpractice, proceeding despite the patient's refusal would not be considered battery. In these situations, the physician would have the burden of proving the patient was not competent. Further, if a patient is determined to be not competent the healthcare providers should attempt to obtain consent from the patient's next of kin.
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