Case Scenario: CAN A PHYSICIAN "CHANGE HIS OR HER MIND"?

Walls had a condition that caused his left eye to be out of alignment with his right eye. Walls discussed with Shreck, his physician, the possibility of surgery on his left eye to bring both eyes into alignment. Walls and Shreck agreed that the best approach to treating Walls was to attempt surgery on the left eye. Before surgery, Walls signed an authorization and consent form that included the following language: I hereby authorize Dr. Shreck to perform the following procedure and/or alternative procedure necessary to treat my condition of the left eye. I understand the reason for the procedure is to straighten my left eye to keep it from going to the left. It has been explained to me that conditions may arise during this procedure whereby a different procedure or an additional procedure may need to be performed, and I authorize my physician and his assistants to do what they feel is needed and necessary. During surgery, Shreck encountered excessive scar tissue on the muscles of Walls's left eye and elected to adjust the muscles of the right eye instead. When Walls awoke from the anesthesia, he expressed anger at the fact that both of his eyes were bandaged.

The next day, Walls went to Shreck's office for a follow-up visit and adjustment of his sutures. Walls asked Shreck why he had operated on the right eye, and Shreck responded that "he reserved the right to change his mind" during surgery. Walls filed a lawsuit. The trial court concluded that Walls had failed to establish that Shreck had violated any standard of care. It sustained Shreck's motion for directed verdict, and Walls appealed. The court stated that the consent form that had been signed indicated that there can be extenuating circumstances when the surgeon exceeds the scope of what was discussed presurgery. Walls claimed that it was his impression that Shreck was talking about surgeries in general. Roussel, an ophthalmologist, had testified on behalf of Walls. Roussel stated that it was customary to discuss with patients the potential risks of a surgery, benefits, and the alternatives to surgery. Roussel testified that medical ethics requires informed consent. Shreck claimed that he had obtained the patient's informed consent not from the form but from what he discussed with the patient in his office. The court found that the form itself does not give or deny permission for anything. Rather, it is evidence of the discussions that occurred and during which informed consent was obtained. Shreck therefore asserted that he obtained informed consent to operate on both eyes based on his office discussions with Walls

Ethical and Legal Issues

1. Discuss the conflicting ethical principles in this case.

2. Did the physician's actions in this case involve medical paternalism? Explain your answer.