Casuistry is a popular ethical theory used heavily in the field of law. In general, landmark cases are applied to the current situation/question at hand to argue that it is similar to or distinct from landmark cases and should be approached similarly or differently, respectively. Below are some ethical/legal cases that seem relevant for those interested in interventional radiology.
Johnson v. Kokemoor, 1996
Ms. Johnson was found to have a large posterior circulation aneurysm. Dr. Kokemoor recommended clipping the aneurysm and told Ms. Johnson he had performed many such surgeries, comparing the risks to those of routine operations (~2%). Unfortunately, this operation left Ms. Johnson with quadrapeligia and eye and speech impairment. Since resideny, Dr. Kokemoor had only operated on basilar bifurcations anqurysms twice and never on one as large as Ms. Johnson’s. According to expert witnesses, this operation would have carried a 7-10% risk in the hands of the most experienced surgeons and closer to a 20-30% risk with Dr. Kokemoor’s experience.
The courts found Dr. Kokemoor guilty based on previous definitions of negligence being present when a reasonable person would have chosen a different action if the withheld information was presented. In other words, the courts felt that Dr. Kokemoor’s inexperience was material information that would have caused a reasonable person to avoid the surgery and resulting damages. This is significant as it is one of the first times characteristics specific to an individual physician has been considered material information for informed consent.
In re Cook, 2014 & In re Bard, 2015
Both Cook and Bard have been named in a growing number of class actions over the last few years regarding their IVC filters. Due to this growing number of cases, concerning similar questions of facts the U.S. Judicial Panel on Multidistrict Litigation decided to centralize these lawsuits into two multidistrict litigations (MDLs): 27 suits concerning Cook filters were centralized to the Southern District of Indiana in October 2014 and 15 actions plus 5 potential tag-alongs concerning Bard filters were centralized to the District of Arizona in August 2015.
The primary legal question concerns whether or not Cook’s and Bard’s filters possess design and/or manufacturing defects making them unreasonably prone to complications. In defense, these companies argue that the FDA’s prior approval of their filters should protect them from such litigation and their filters expose patients to comparable risks to other filters. The first Cook MDL trials should begin in mid to late 2016.
For more information check out this article
In re Quinlan, 1976
At the age of 21, Karen Quinlan stopped breathing for two 15 min periods after mixing sedatives with alcohol while on a crash diet. She was taken to a nearby hospital and placed on a ventilator by Dr. McGee. She was seen 3 days later by Dr. Moore who found her to be in a persistent vegetative state. She had sleep-wake cycles, made noises, maintained blood pressure, et cetera, but she had no cognitive function and was predicted not to recover. Her father wanted to take her off the ventilator but Dr. Moore and the hospital refused because she was not brain dead.
The courts ruled in favor of Mr. Quinlan. Patients have a right to refuse life saving interventions and this right can be exercised by a surrogate decision maker. The state’s interest in preserving life declines and patient’s right to privacy increases as the prognosis worsens and invasiveness of the required intervention increases. The ventilation was not curative but instead sustaining and prolonging her eventual decline. Removing Karen’s ventilator was not causing her death but instead allowing her to succumb to her underlying condition.
McFall v. Shimp, 1978
Mr. McFall was a middle aged man who developed aplastic anemia and needed a bone marrow transplant to live. His cousin, Mr. Shimp, was the only available donor and he refused to donate his marrow to his cousin.
The court ruled in favor of Shimp, citing that individuals are generally not required to save others outside of very specific relationships. To intrude upon Shimp’s bodily integrity would undermine our basic freedom. Even with such a relationship, the courts noted that forcing the risks of bone marrow donation on Shimp would likely not be required.
Vacco v. Quill, 1997
In 1991, a palliative care physician named Timothy Quill published a New England Journal of Medicine article
describing how he assisted in the suicide of a terminally ill patient with leukemia. A number of physicians filed suits challenging New York’s law against physician-assisted suicide (PAS), claiming it violated the Equal Protection Clause of the Fourteenth Amendment.
An appellate court found the New York law to violate the constitution but this was overturned by the U.S. Supreme Court. They held that PAS is distinct from terminal sedation and withholding treatment, emphasizing the line between commission and omission. Dr. Quill has continued to argue against the principle of double effect in bioethics (derived from the work of Thomas Aquinas), which is used to differentiate terminal sedation from PAS. In short, a morally bad act (e.g. killing) cannot be a means to a good end (relief from pain/suffering) or the end itself. However, if the nature of the act is good and intends to have a good effect (sedation and pain relief), a bad effect may still result (e.g. death) without the act being considered morally wrong. In other words, deliberate administration of potentially unsafe doses of a sedative is justified if the intended end is pain relief, even if there is a possibility of causing death. Other scholars and communities have disagreed, and so PAS is legal in a number of countries and some U.S. states.