While Mr. B did sign a general consent, these forms are primarily designed to cover “medical necessities” in emergencies: A patient has a cardiac arrest during a knee operation and needs immediate heart surgery, or an intestinal malignancy is discovered during an appendectomy and removed. “Medical necessity” takes on a different meaning in nonemergency contexts, especially when the additional procedure is so traumatic.
This defense attorney wisely advised Dr. U that he might be better off avoiding a trial. Judges always instruct jurors to resist allowing their emotions to interfere with how they apply the law; but any man on this jury would be likely to see himself in Mr. B’s place and have a difficult time dispassionately assessing whether penile amputation was the best medical choice. Certainly the fact that neither the patient nor his wife was consulted prior to such a radical procedure would arouse compassion in jurors – both male and female.
Consent forms, no matter how well written, cannot substitute for good judgment. Dr. U’s desire to spare his patient a second round of anesthesia may have been valid, but proceeding with a surgery that so profoundly changes how a man views himself, not to mention his sexual and urinary functionality, was unwise. If avoiding a second anesthesia was so vital, Dr. U could have at least stepped into the waiting room and consulted Mr. B’s wife.
Dr. U may also have been correct that penectomy was the best treatment for this patient’s cancer, but squamous cell carcinoma is not so fast-moving that Mr. B couldn’t have been given a few days to get used to and accept the idea of the amputation. In the absence of an imminent threat of death, it is always best to prepare a patient for such a life-altering procedure and allow him the opportunity to give specific consent.
Ms. Latner, a former criminal defense attorney, is a freelance medical writer in Port Washington, N.Y.