Our judge, in her tentative
decision, described the legal requirements and guidelines (with case sources for those citations) for informed consent as
has a duty to inform a patient in lay terms of the dangers inherently and potentially involved in a proposed treatment. (Cobbs
v. Grant (1972) 8 Cal.3d 229, 243; McKinney v. Nash (1981) 120 Cal.App.3d 428, 440.)
The scope of a
physician’s duty to disclose is measured by the amount of knowledge a patient needs in order to make an informed choice.
All information material to the patient’s decision should be given. (Cobbs, supra, at 245.)
information is that which the physician knows or should know would be regarded as significant by a reasonable person in the
patient’s position when deciding to accept or reject the recommended medical procedure.” (McKinney,
supra. at 440.)’
In the trial, the judge
asked UCD VMTH’s attorney the specific question as to whether UCD VMTH believed they must disclose to the pet guardian
the risks involved in surgery—and you see that UCD VMTH says “no”.
UCD VMTH does not believe they are required to meet the legal guidelines for informed consent.
Moving away from the legalistic terms, let’s explore what informed consent means to you, the pet guardian. Pet
guardians have a right to make an informed decision about what diagnostic tests will be performed upon their pet. When the procedures being authorized are diagnostic procedures, the issue of informed consent is simplified;
and the doctor is merely explaining to you what tests he/she believes will allow him to determine what exactly is wrong with
your pet. The important issues at this stage are providing you with information
regarding the reasons for and risks of performing these tests, and the cost. Since
the fees for diagnostic tests are generally derived from a fee schedule, there should not be a significant margin of error
in this cost estimate.
Once a diagnosis is reached,
pet guardians also have a right to make an informed decision about their pet’s treatment. Informed consent is the process of giving guardians the information they need to make decisions, including
the full spectrum of choices as to what the guardian can do. This would include
no treatment, partial treatments ranging to definitive treatment and the various methods to accomplish each. For each possible treatment procedure the guardian should
be provided the medical benefit, specific risks of the procedure, likelihood of success/probable outcome, and estimated cost
of the proposed procedure. The consequences of not providing treatment should
be explored with respect to advising the guardian if failing to treat would cause the pet undue suffering, in which case immediate
euthanasia might be suggested. Informed consent is more than a signed form in
the pet’s file. It is a detailed discussion between veterinarians and guardians,
and all informed consent discussions should be documented in the pet’s medical record.
Notes should be made about the guardian’s decision and any questions that were asked and the answers given.
Often, veterinarians have
written consent forms (such as UC VMTH did) which a guardian is asked to sign before treatment can begin. However, these forms are ALWAYS incomplete with respect to establishing whether informed consent was really
provided. This is because the form you sign provides the risks, costs and required
details for only the treatment you decide upon.
It does not establish that the veterinarian provided you with all your options, as informed consent requires. This signed document (consent to treat) is considered a contract for services between
you and the veterinarian, and it is important that you treat it as such.
And finally, it is critical for you to understand that THE VETERINARIAN, as the more knowledgeable party
to the contract, is solely responsible for ensuring that you have been provided
all the information needed to make an informed decision, and it is the doctor’s responsibility to be sure YOU UNDERSTAND
the information given you and the decision you have made as well as all its ramifications.