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Informed Consent: Clarified and Extended

In McQuitty v. Spangler, the Maryland Court of Appeals held that a physician is liable to his patient for harm that results from the physician's failure to disclose the material risks and benefits of a proposed treatment or therapy even when that treatment is not surgical or physically invasive in nature. Therefore, a physician is required to obtain his patient's informed consent to delay surgery as well as to proceed with surgery.

A. The Facts

Peggy McQuitty was admitted to a Maryland hospital for vaginal bleeding when she was 28 weeks pregnant. Donald Spangler, M.D., an obstetrician, was her primary attending physician. An ultrasound revealed a partial placental abruption, which is a premature separation of the placenta from the uterus. It is an irreversible condition that can reduce the supply of oxygen and nutrients to the fetus, which can lead to fetal injury and even death.

Dr. Spangler developed a plan to deliver Ms. McQuitty's baby by Cesarean section at a later date so as to allow time for the fetal lungs to develop further. However, delaying a Cesarean section also increases the risk of further separation of the placenta from the uterine wall, which is what ultimately occurred. Thirty eight days after her hospital admission, Mrs. McQuitty experienced a complete abruption, requiring an immediate emergency Cesarean section. As a result of that abruption, her son Dylan was born with severe cerebral palsy

B. Legal Proceedings
Mrs. McQuitty filed suit against Dr. Spangler and other health care providers. One of her claims was that Dr. Spangler failed to obtain her informed consent to delay the Cesarean section until she suffered the complete abruption.

The informed consent doctrine requires a physician to explain medical treatment to his or her patient, and to warn of any material risks or dangers of the treatment, so the patient can make an intelligent and informed decision about whether or not to go forward with the proposed treatment. However, Dr. Spangler had not offered Mrs. McQuitty the option of delivering her baby by Cesarean section at any time prior to her complete abruption.

A jury found that Dr. Spangler had not committed medical malpractice but was unable to reach a verdict as to Mrs. McQuitty's informed consent claim. At a second trial, that addressed the informed consent issue only, a jury returned a verdict in favor of Mrs. McQuitty.

However, the judge at that second trial set aside the verdict on the ground that the doctrine of informed consent did not apply in the absence of an affirmative violation of a patient's physical integrity. Specifically, the injury to Dylan had allegedly occurred because of Dr. Spangler's delay in performing the Cesarean section, not as a result of any operation or other affirmative physical act on his part.

The Maryland Court of Special Appeals, Maryland's intermediate appellate court, also found in favor of Dr. Spangler on the ground that an informed consent claim requires a physical invasion.
Maryland's highest appellate court, however, reversed and reinstated the jury's verdict in favor of Mrs. McQuitty. The court explained that, under the informed consent doctrine, a health care provider has a duty to inform his patients of those risks that would be material to the intelligent decision of a reasonably prudent patient. The purpose of imposing a duty to communicate such information is to enable that patient to make an intelligent and informed choice, after full and frank disclosure of the material risks and the benefits of a proposed course of treatment.

The court rejected Dr. Spangler's argument that the informed consent doctrine is an offshoot of the law of assault and battery, which requires a nonconsensual touching or reasonable apprehension of the same. Instead, it noted that the doctrine is predicated upon negligence, and more specifically upon the physician's duty to provide information, rather than his or her physical actions.

The imposition of a duty to disclose material risks of a course of medical treatment respects a patient's right to determine what may be done to his or her body and when, so as to enable the patient to make an informed choice about whether or not to undergo treatment. Accordingly, Maryland's highest court concluded that an affirmative physical invasion requirement would "contravene the very foundation of the informed consent doctrine - to promote a patient's choice." Instead, it would countermand the patient's choice by permitting the health care provider to make treatment decisions without the patient's involvement in the health care choice.


January 07, 2010




Rosen, Barry F.


Health Care