Georgia Darviris Case Summary

Imagine waking up from surgery believing you underwent a completely different procedure than what you first had imagine. That's what Georgia Darviris had to experience in the winter of 2004. She gave consent for the doctor to perform a simple fissurectomy. After waking up, Darviris had been informed she underwent a hemorrhoidectomy. A completely different surgery. She was given a spinal anesthetic before her preformed surgery, therefore she was awake. She claimed that a nurse nor her doctor, Petros, gave any indication during the surgery that she wasn't receiving the planned fissurectomy. She argued that she would not have consented to this procedure due to a family member having major complications with the same surgery. After receiving
this surgery she experienced excruciating pain and had to undergo a surgery, which confirmed her original wounds had not healed properly.
There are many different requirements depending on the type of consent given, whether written or verbal, or if the consent is for a research study or a procedure.
Required in all cases and in every form of consent is a “description of any reasonably foreseeable risks or discomforts to the subject” If a procedure had more than a minimal risk then “an explanation as to whether any medical treatments are available, if injury occurs and, if so, what they consist of, or where further information may be obtained” must be provided. In the case where the patient is consenting to a research study the rules and requirements are different, required is a statement stating that
“refusal to participate will involve no penalty or loss of benefits to which the subject is otherwise entitled, and the subject may discontinue participation at any time without penalty or loss of
benefits” must be provided to the patient. The patient must be aware that the study is not required and everything they agree to is voluntary. They also must be provided with the information stating refusing participation in the study won't have a negative effect on said patient. Another requirement for informed consent forms regarding research studies is a “contact for answers to pertinent questions about the research and research subjects' rights, and whom to contact in the event of a research-related injury to the subject.” Patients are required to be given information on who to contact for more extensive information and answers on the study. Although there are many regulations to informed consent, there are also some special exceptions to the rules. (Informed Consent Checklist) Informed consent is a very tricky and confusing topic. Depending on the physical and mental state of the patient, it determines if they are fit enough to provide consent for themselves. The law states that “ a person eighteen (18) years or older may consent to medical treatment for himself or herself.” (Informed Consent for) Although, there are many situations where this rule isn’t required. There is assumed competency in all adults,
“when there is a question that the individual patient cannot give his or her consent for treatment, a judicial determination and/or a medical evaluation by a neurologist, psychiatrist or other specific health care providers must take place and be documented.” (Brent) A medical evaluation is required if there is any indicators that a patient may be unfit to give consent for a procedure. There are other factors that can determine whether or not someone is allowed to give consent. Such as, marital status or whether or not the patient is a parent, “A minor who is married or the parent of a child has the same capacity as an adult to consent to medical treatment.” (Informed Consent for) If a minor is a parent the minor must provide consent for not only themselves, but also their child, “the minor must consent for all medical treatment for himself/herself and for his/her child, and by parallel application, must consent for all research for himself/herself and his/her child.” (Informed Consent for) While there are many exceptions to informed consent, there are also many cases where consent cannot be obtained. If your child was in a life threatening car accident and doctors were unable to reach you, would you want your child’s life to be saved or do you want doctors to wait until you give consent? In some cases , the better medical treatment is to operate on a patient without informed consent.For a doctor to prevent getting in trouble for doing an operation without consent “there must be reasonable evidence that the [procedure] has the potential to provide real and direct benefit to the patient.” (Exception) Other reasons why consent might not be obtainable are if the patient is alone and under the age of 18 or if the information about the procedure would cause direct harm with the family and/or patient. If the family requests the procedure information to be withheld then that information won't be told to the patient, “Often families will ask the physician to withhold a terminal or serious diagnosis or prognosis from the patient.” (Braddock III) Usually this information is requested to be kept from a patient to prevent them from hearing painful news or news that might cause them to lose hope. If the family discloses information to a the doctor such as mental instability within the patient that “causes the physician to worry that truthful disclosure may create real and predictable harm” (Braddock III) information might be kept. “Examples might include disclosure that would make a depressed patient actively suicidal,” ( Braddock III) other examples of this could be mental instability. It must be an obvious risk or harm involving the patient, it can not be a hypothetical risk that may happen. Doctors are put in very tough situations, but they have to make that decision. There are many instances where malpractice involving lack of consent in an operating room can lead to a lawsuit.
A patient can not win a lawsuit with a doctor for claiming that the doctor did not comply with consent forms the patient must have been injured and “there must be a connection between the lack of informed consent and your injury.” The patient must claim “with the right information, you wouldn't have consented to the medical treatment that ended up harming you” An example previously mentioned would be the Darviris vs. Petros case, Darviris claimed she wouldn't have agreed to the procedure performed on her because of a family member’s complications with the same procedure. To win a malpractice lawsuit related to informed consent “the harm you suffered wasn't disclosed as a known risk of the procedure, even though most doctors would have discussed that particular risk as part of the informed consent process.” If a doctor kept risks from a patient and those risks harmed the patient the lawsuit would usually favor the patients. An lawsuit example would be Martin vs. Lowney, MArtin claimed that ehn being explained the procedure she was told that the scar would be one inch in length. When she woke up she had a six inch scar on her stomach. She accused Lowney of not explaining in full detail all the risks of the operation and not providing all information required for informed consent. When MArtin was explaining the incision had released bacteria into her bloodstream it
came out that the bacteria was due to the appendectomy and not the incision itself. Due to the fact Lowney failed to mention to Martin that an infection was a risk of the operation she won the case. (Goguen) There are many special circumstances as well as normal procedure risks that might prevent a patient from going through with a surgery. “[Patients have] got the right of self-determination,” (Rao) every patient had the right to decide what happens to their body. All informed consent studies and procedures are voluntary, patients are not required to sign them. “The [patient] may choose to avail no treatment because of religious belief,” (Rao) an example of this would be a Jehovah’s witness. Its very difficult to perform a procedure on a Jehovah’s witness due to the fact, “Members of this faith have deep religious convictions against accepting homologous or autologous whole blood.” (Jehovah’s) A witness in this religion will normally wear a bracelet or a necklace, in the case of an accident paramedics and doctors will then prevent any form of blood transfusions for said witness. Another reason a patient might reject an operation is the simple fact they just don't want the procedure done. It's a doctor’s duty to inform a patient and/or parent of the risks of a surgery and the consequences if the surgery does not take place, but a doctor or nurse can not make the decision for the patient. The only thing a doctor can do is inform their patient and let the patient decide for themselves, “Doctor's duty is to explain the possible consequences of non-treatment and benefits of treatment and leave the decision to the parent.” Nobody can force a patient to let another being preform an operation on the patient, that's their right. Performing a procedure on a patient who does not comply with the surgery could be filed as battery. A parent can decline treatment “but, a patient's freedom cannot impinge on the rights of others or cause harm to a third party or community.” (Rao) This means that a patient who rejects treatment can not participate in school activities if the child could infect or harm another student and/or teacher. In the case of an informed refusal the doctor should make it very aware on the patient's medical records what they left AMA, or against medical advice. If this statement is not written directly on the patient's records then a lawsuit could be filed if sickness or a death were to occur. It's completely the patient's’ choice as to what they choose to do with their body. Informed consent is a very confusing topic because of all of the details and layers of the whole topic. There are many rules and requirements to be able to properly give consent, such as knowing all the risks. There's quite a few exceptions when giving consent depending on your mental state or age. Patients also have the power to refuse an operation. If malpractice occur then a lawsuit can be filed, but there are also many occurrences where consent cannot be given due to the patient being a minor or the patient being unconscious and in critical condition. To prevent a mistake occurring while giving consent, be sure to completely understand the procedure and risks, then make an educated decision based on that information.