Katharine C. Rathbun

Legal Issues in Critical Care Medicine

This article introduces some of the legal problems facing physicians practicing critical care medicine. Although there is considerable scholarship dealing with the legal and ethical consequences of withdrawing life-sustaining care from terminally ill or irreversibly comatose patients, little has been written about the legal problems that are the inevitable consequence of the pressure to reduce expenditures for intensive care. Because this is a new area of inquiry, this article draws lessons from analogous situations such as anesthesia care. It is important to stress that legal standard setting may be influenced by concerted action by critical care practitioners; however, if the profession is silent on standards, the law will impose standards that it arrives at in an ad hoc fashion.

A Procrustean Approach to Informed Consent: The Texas Medical Disclosure Panel

0 ne of the central dilemmas in contemporary medical practice is determining how much information a patient needs to make an informed choice of medical care alternatives. O n June 1,1982, Texas began an experiment that requires specific information to be given to patients about to undergo selected medical procedures.’ The objective of this uniform disclosure is to reduce the threat of medical malpractice lawsuits based on a failure of informed consent. While this is of benefit to physicians, it is unclear whether patients’ needs for information, like the unfortunate guests of Procrustus, will be cut and stretched to fit an inflexible standard. This article reviews the antecedents of this approach to informed consent, the legal and philosophical problems involved in uniform disclosure standards, and the practical problems that uniform disclosure standards pose for health care providers.