LANDMARK CASES IN FORENSIC PSYCHIATRY:

Informed Consent

Dr. Spence, a neurosurgeon, performed back surgery on Canterbury. Canterbury subsequently fell from his hospital bed, becoming paraplegic.
Canterbury sued for negligence, stating that he wasn’t informed of the small (~1%) inherent risk of paralysis.
Dr. Spence argued that informing patients of this risk may deter them from necessary surgery.
DC Court of Appeals defined the disclosure requirements for informed consent to be based upon what a “reasonable person” would find material to decision making.
- Defined exceptions for disclosures that may cause harm, as well as emergencies.

Failure to disclose the rare, yet serious, potential risks of a medical procedure is grounds for malpractice.
“Reasonable Person” Standard for Informed Consent: what the average, reasonable person would consider material to a decision.

Kaimowitz, a third party, sued the Michigan Department of Mental Health to prevent them from performing experimental psychosurgery on an involuntarily committed psychiatric patient without adequate informed consent.
Ruling stated that involuntary psychiatric patients (and guardians) can’t provide valid informed consent for experimental psychosurgery.
- Institutional environment is inherently coercive, undermining voluntariness.
- Experimental procedures lack established medical consensus, and present significant risks without known benefits.

Involuntary psychiatric patients and their guardians are unable to provide valid informed consent to experimental psychosurgery due to the inherently coercive environment and lack of medical consensus.
Applies specifically to experimental psychosurgery, not all medical procedures

Nancy Cruzan was in a persistent vegetative state for many years following a car accident. She had no cognitive function, and a feeding tube in place for nutrition.
Cruzan’s parents petitioned for removal of the feeding tube, stating that she wouldn’t have wanted to live in this condition. She had no advance directive.
Missouri Supreme Court ruled that in absence of a living will or clear and convincing evidence of Cruzan’s wishes, her parents didn’t have the authority to make this decision.
US Supreme Court upheld this decision.

“A state may require clear and convincing evidence of an incompetent individual’s desire to withdraw life-sustaining treatment before the family may withdraw life support for that individual.”
There is a balance between a patient’s right to privacy and a state’s interest in preserving life.