Order in the Steinhaus case

In April 1986, one-month-old Lance Tyler Steinhaus sustained serious injuries, attributed to abuse by his father, that left him comatose. His mother and his physicians agreed that he should not be treated aggressively. The Redwood County (Minnesota) Welfare Department obtained a temporary order restraining withdrawal of Lance's antibiotic therapy. Lance's mother and Dr. David Steinhorn, a pediatrician, appealed to the County Court to dissolve the temporary injunction. Judge George I. Harrelson in this decision denied their request on the grounds that both state and federal law establish that infants with life-threatening conditions have a right to medically-indicated treatment and that Lance Steinhaus had such a right because he was in a "vegetative state" rather than technically "comatose." [Editor's note: After conducting another hearing on Lance's neurological status, the court ruled on 18 October that Lance was irreversibly comatose and ordered only "comfort care."]     

Competence to consent to treatment as a psycholegal construct

The issue of whether civilly committed patients should be extended the right to accept or refuse treatment has generated much controversy and litigation during the past 15 years. In general, the current rule is that in nonemergency situations, individuals who are competent to give informed consent to treatment should be extended the right to refuse it. Obviously, the manner in which this rule is implemented partly depends on how competence to consent to treatment is defined and measured. Most researchers have implicitly assumed that an understanding of treatment information is the sole criterion of competence. It is argued that such a definition may be incomplete and is in need of reexamination. Following a review and analysis of the relevant legal and psychological literature, a comprehensive construct of competency to consent to treatment is proposed and future directions for research are discussed.     

Rogers v. Whitaker

The High Court of Australia affirmed the Supreme Court of New South Wales' determination that a doctor has a duty to warn a patient of any material risk involved in a proposed treatment. A risk is considered material if a reasonable person in similar circumstances would attach significance to the risk, or if the doctor is, or should be, cognizant that the particular patient would express concern about the risk. The trial court overruled the precept that a doctor could not be found negligent in warning a patient if the doctor acted within the purview of common practice, even though other practitioners may follow different procedures and regardless of the particular patient's concerns. In this case, Maree Whitaker became essentially blind after an unsucessful operation on her right eye caused sympathetic ophthalmia in her left eye. Although there was no question that the surgery had been performed with the requisite skill and care, Ms. Whitaker petitioned the court for relief due to the failure of the ophthalmologist, Dr. Christopher Rogers, to warn her of the possibility (approximately 1 in 14,000) that the sympathetic ophthalmia condition could develop. The trial court's award of damages was affirmed because, in spite of Ms. Whitaker's expressed specific concern that her "good eye" not be harmed, Dr. Rogers did not inform her of the potential risks associated with the surgery.