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Medicine and Public Policy |

Ethics and the Law: Is There Common Ground on Informed Consent for Disparities in Hospital Outcomes?

Nadine Housri, MD; Mary Coombs, JD; Babak J. Orandi, MD, MSc; Timothy M. Pawlik, MD, MPH; and Leonidas G. Koniaris, MD
[+] Article and Author Information

From the UMDNJ Robert Wood Johnson Medical School, New Brunswick, New Jersey; University of Miami School of Law, Miami, Florida; The Johns Hopkins Hospital, Baltimore, Maryland; and Thomas Jefferson University Medical College, Philadelphia, Pennsylvania.


Financial Support: By the James and Esther King Tobacco Research Award from the State of Florida and Arsht Research Grant from the Ethics Program at the University of Miami.

Potential Conflicts of Interest: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M11-0598.

Requests for Single Reprints: Leonidas G. Koniaris, MD, Thomas Jefferson University Jefferson Medical College, 1015 Walnut Street, 620 Curtis Building, Philadelphia, PA 19107; e-mail, Leonidas.Koniaris@jefferson.edu.

Current Author Addresses: Dr. Housri: Cancer Institute of New Jersey, Department of Radiation Oncology, 195 Little Albany Street, New Brunswick, NJ 08903.

Ms. Coombs: University of Miami School of Law, PO Box 248087, Coral Gables, FL 33124.

Dr. Orandi: The Johns Hopkins Hospital, 600 North Wolfe Street, 655 Blalock, Baltimore, MD 21287.

Dr. Pawlik: The Johns Hopkins Hospital, 600 North Wolfe Street, Harvey 611, Baltimore, MD 21287.

Dr. Koniaris: Thomas Jefferson University Jefferson Medical College, 1015 Walnut Street, 620 Curtis Building, Philadelphia, PA 19107.

Author Contributions: Conception and design: N. Housri, M. Coombs, L.G. Koniaris.

Analysis and interpretation of the data: N. Housri, M. Coombs, B.J. Orandi, L.G. Koniaris.

Drafting of the article: N. Housri, M. Coombs, B.J. Orandi, T.M. Pawlik.

Critical revision of the article for important intellectual content: N. Housri, M. Coombs, B.J. Orandi, T.M. Pawlik, L.G. Koniaris.

Final approval of the article: N. Housri, M. Coombs, T.M. Pawlik, L.G. Koniaris.

Administrative, technical, or logistic support: N. Housri, L.G. Koniaris

Collection and assembly of data: N. Housri, M. Coombs, B.J. Orandi, T.M. Pawlik, L.G. Koniaris.


Ann Intern Med. 2011;155(4):260-264. doi:10.7326/0003-4819-155-4-201108160-00010
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The association between procedure volume at institutions and outcomes of cancer surgeries has been widely published in the medical literature; discussed in the lay press; and, during the past 15 years, incorporated into quality improvement endeavors. In certain cases, institutional volume has become a proxy for quality. Despite the vast amount of retrospective data on this topic, physicians generally have been unsure how to approach the information and interpret it for their patients. Even more challenging to some physicians has been deciding whether the data oblige them to either direct patients with cancer to high-volume centers for care or discuss the data with these patients as part of informed consent. An additional challenge is that physicians must understand laws related to these issues and that these laws are unclear. This article reviews the ethical arguments for including disparities in hospital outcomes as part of informed consent and examines whether legal precedent can shed light on this debate.

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Communication and the law
Posted on September 13, 2011
Kaspar F. Sertl
No Affiliation
Conflict of Interest: None Declared

Letter to the Editor:

To the article Ethics and the Law............" 2011;155:260-264

It is a basic problem in all kinds of comunications, if its at the court or if its informed consent. The basics of communication is: "the listener and/or reader decides what is said and/or written." So even when informed consent is for autonomy, nonmaleficence, beneficence and justice, there is nothing like the one right thing to do. This is especially true when something went wrong. (K.Weick University of Michigan: "How should I know if something is good as long as I do not know if I am succesfull.") Each decision of a (especially high) court regarding informed consent must be pure arbitrariness. Judges do not know what the physician said and even more he cannot have any idea whatsoever, what the patient heard. Any verdict says a lot about the judge but almost nothing about the informed consent process before the surgery took place = the listener decides what he hears.....

Univ.Prof.Dr.Kaspar SERTL Internal Department, Krankenhaus Floridsdor Vienna, Austria

Conflict of Interest:

None declared

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