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  • Title: Elective sterilization: no guarantees.
    Author: Avery JK.
    Journal: J Tenn Med Assoc; 1984 Sep; 77(9):540-1. PubMed ID: 6492788.
    Abstract:
    The patient, surprised by an unexpected resullt, i.e., pregnancy, claimed her doctor was negligent. The 32-year-old, para 3, gravida 3, presented herself to her gynecologist requesting a tubal ligation. A thorough examination revealed no contraindications for surgery or general anesthesia. The patient and her physician discussed various sterilization methods, and the patient chose a method designed to occlude the fallopian tubes. Admission was arranged for 1 month later and the patient was given a booklet written by the manufacturer of the occlusion device to read in the interim. The booklet described the procedure and its risks and benefits. After admission, the physician asked the patient if she had read the booklet to which she responded affirmatively. When asked, she told the doctor she had no questions. The doctor then had the patient sign a standard consent form. The pregnancy wa discovered during a routine check-up. She filed suit for alleged negligence in performing the tube occlusion surgery. The physician testified at the trial that he had never personally read the booklet that he gave his patients but had assumed it explained the procedure better than he could. The patient testified that the doctor had asked if she had read the booklet but denied saying she had. The patient could sign her name but, in fact, could not read. She also stated that the doctor indicated that the procedure was intended to be permanent. The booklet stated, "If applied properly, this device will not fail." The facts fail to point to negligence in his performing the procedure, but there is no record or documentation of informed consent. The doctor relied on a written manufacturer's booklet that he had not read and did not follow up with his own comments to assure that the patient understood. Informed consent is a process that requires the patient to receive enough information to make an informed decision about what the doctor will do. Without sufficient information, the patient may be surprised at the outcome and might sue the doctor, claiming that if only she had known of the risk, she would not have consented to that procedure or might have opted for anothe course of action. Doctors also can find themselves with legal problems if they make statements that the patient construes as warranties or guarantees. Apparently the doctor did not explain that there was no absolute guarantee of sterility. Discussion of the procedure and its benefits and risks should be documented.
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