“…the doctor began by conducting a diagnostic laparoscopy but followed it up immediately thereafter, having obtained additional consent only from the patient’s mother (as the patient was still unconscious), with a second and more elaborate treatment procedure (‘laparotomy’) that resulted in removal of the patient’s uterus and ovaries (hysterectomy and bilateral salpingo-oophorectomy). [The patient, upset over this fact, refused to pay upon discharge. The doctor sued for recovery of charges and got a favorable ruling from the National Consumers' Commission. The patient appealed in the SC]. The consent form signed by the patient at the very beginning stated that the patient had been informed that the treatment to be undertaken is ‘diagnostic and therapeutic laparoscopy. Laparotomy may be needed’. The outcome of the case turned on the definition of ‘laparotomy’ – the word simply refers to opening the abdomen; so, in this instance, did it also imply consent to remove organs from the patient’s abdomen after it had been opened (as the doctor argued)? The court’s answer was in the negative and it emphasized that if that was indeed the case, the consent form ought to have read “”diagnostic and operative laparoscopy. Laparotomy, hysterectomy and bilateral salpingo-oopherectomy, if needed.”

It is a real life situation that has plagued many women who wanted their gynecological problems solved, and instead, ended up without their reproductive organs to the end of their days.

It really is in the discretion of the surgeon. The patient is unconscious, and may not be able to undergo another major surgery if the surgeon woke her up just in order to ask her whether she would like to have the foci of cancer, for example, preserved…

Now let’s reverse the situation. The consent only gave permission for some surgery and not for any radical surgery at all and let’s suppose that the surgeon visually found out the masses of cancerous tissue all over the uterus and abdomen? Wouldn’t he be neglecting his duty to cure if he just dully noticed that the patient is soon going to die but what the heck, there is no written consent, so let her wake up and then tell her the situation. Would she still be suing him for not operating properly on her?

The moral of the story is — you never know what will happen. And that is why I am always advocating avoiding hysterectomy if possible, not going for it like it’s a picnic… because it is not!

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