b. The Extension Doctrine. The traditional rule has been that the physician
cannot exceed the scope of permission he or she was given, that is, only those
procedures specifically authorized by the patient can be performed. More recently, the
courts have begun to recognize the medical reality that it is usually more sensible to
perform any necessary additional procedure as part of the originally authorized
procedure. If a life-threatening situation arises during surgery, which was not covered
by the consent form because it was unknown, then consent of a family member may be
sought. But, if the situation is so emergent as to prevent that, then the extension
doctrine may be applied and no consent is necessary in order to save the patient's life.
EXTENSION OF CONSENT
In Kennedy vs. Parrott (N.C., 1956), the surgeon punctured some cysts that he found
on the patient's ovaries during an appendectomy (for sound medical reasons),
although he had no express authorization to do so. The court found an implied
extension of consent, even though the extended procedure resulted in phlebitis,
which necessitated additional surgery. The court recognized the surgeon's
autonomy to react to unexpected conditions that could not be known beforehand,
especially since the cysts were within the realm of eyesight of the original incision.
EXTENSION OF CONSENT NOT FOUND
In Wells vs. Van Nort (Ohio, 1919), a surgeon was held liable for removing a
patient's ovaries and fallopian tubes when express consent had only been given
for an appendectomy. The doctor's defense that the organs were diseased was
rejected on several grounds. There is an implied prohibition against any
procedure not expressly consented to. In addition, implied consent to removal of a
body part or reproductive capacity is usually not found.
1-20. PATIENT WAIVER AND PRIOR PATIENT KNOWLEDGE
a. Patient Waiver. There is no legal obligation to disclose information that the
patient does not wish to hear. But, physicians must be careful with this doctrine, as it
can only be relied upon when the patient has clearly expressed his or her wish not to
receive that information. The physician should find out why the patient does not want to
know any of the particulars, and should see if there is any way in which it would be
acceptable to the patient to receive said information. A waiver is very risky because if
there is subsequent discontent or a bad result, it may be difficult to establish that the
waiver was not physician-initiated.
b. Prior Patient Knowledge. There is no liability for nondisclosure of risks that
are common knowledge or that the patient has previously experienced.