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Consent for surgery obtained while on operating table (14HDC00307)
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Obstetrician & gynaecologist ~ Informed consent ~
Communication ~ Patient advocacy ~ Total abdominal hysterectomy ~
Oopherectomy ~ Rights 5(2), 7(1)
A 46-year-old woman had suffered from epilepsy since childhood,
and also experienced menstrual problems. The woman considered the
option of undergoing a total abdominal hysterectomy (TAH) for
approximately a year, before giving consent to the procedure.
During the same consultation in which she consented to a TAH,
the woman's obstetrician & gynaecologist (O&G) diagnosed
her with catamenial epilepsy (a subset of epiliepsy where a woman's
seizures are exacerbated by her menstrual cycle). The O&G said
that he would have explained to the woman what catamenial epilepsy
was. The woman recalled that she and the O&G discussed that
there was a relationship between her epileptic seizures and her
menstrual cycle, but said that she was not told at any stage that
she had been diagnosed with catamenial epilepsy. It is not recorded
in the clinical notes that the woman's diagnosis of catamenial
epilepsy was discussed with her.
Approximately four months after providing consent, the woman
presented to hospital for her surgery. While she was on the
operating table, the anaesthetist had a conversation with the
O&G. There are differing recollections as to what was said
between the anaesthetist and the O&G. However, following the
conversation, the O&G approached the woman on the operating
table and sought her consent to the removal of her ovaries (BSO).
The woman signed her consent to undergo a BSO. With regard to
giving consent to the BSO, the woman felt "immensely pressured" to
make a decision.
It was held that the manner in which the woman's consent was
obtained for the BSO was not appropriate. The operating theatre was
not an appropriate environment for the informed consent process to
take place, and did not allow for effective communication between
the woman and the O&G. Accordingly, the O&G breached Right
Furthermore, the woman was not given sufficient time to consider
whether she wished to have a BSO, and was not in a position to give
informed consent to the removal of her ovaries. Accordingly, the
O&G breached Right 7(1).
The clinical care provided to the woman by the O&G was
within accepted standards. However, adverse comment was made that
the O&G did not appear to have communicated clearly to the
woman that he had diagnosed her with catamenial epilepsy.
The district health board was not found in breach of the
Adverse comment was made with regard to the failure by
clinicians in the operating theatre to advocate appropriately on
behalf of the woman.