Squamous cell cancer is discovered during a circumcision. Is that justification for additional emergency surgery?

Physicians and hospitals typically require patients to sign a boilerplate consent form before surgery. These forms usually specify that in the event of an emergency or unforeseen medical issue, the physician has the patient’s consent to do whatever is medically necessary under the circumstances.

But can a general consent form protect a surgeon when he performs a penectomy in the course of a circumcision?

Dr. U, 54, was a board-certified urologist with almost 25 years’ experience. His practice was doing well, treating both routine and less common complaints.

One of his patients was Mr. B, a 61-year-old white man who had been complaining of inflammation, foreskin soreness and tightness, and drainage from the penis. Dr. U recommended circumcision, and after discussing it with his wife, Mr. B agreed to the procedure.

On the day of the operation, a nurse checked Mr. B’s vital signs and gave him a consent form to sign. During the circumcision, Dr. U noticed a suspicious lesion on the penis shank. He sent a specimen to the pathology department for biopsy, and the results confirmed his diagnosis: squamous cell carcinoma. Rather than subject Mr. B to a second surgery under general anesthesia, Dr. U decided to perform an immediate penectomy.

When the patient came out of anesthesia, Dr. U sat down with him and his wife to explain what had happened.

“I’m very sorry to have to tell you this,” he said, “but I discovered a lesion, a skin cancer of the penis. It was medically necessary for me to remove your penis in order to protect you from the cancer’s spreading.”

The patient’s shock soon gave way to anger.

“How could you do this!” he shouted. “You didn’t even ask me! You didn’t let me think about it. You didn’t give me time to prepare. You’ve ruined my life!”