Informed consent to medical procedures is absolutely necessary: true or false? While nearly every medical layman would answer “true”, a widely-publicised lawsuit in New York shows that it’s not so simple. Back in 2003, 38-year-old Brian Persaud received a nasty knock on the head while working on a Manhattan construction site. He received eight stitches for a cut over his eye. Then he was told that he needed an immediate rectal examination to check for spinal cord injury. (For non-medicos: a gash on the head might have been accompanied by more severe damage to the spinal cord. An check of rectal sphincter tone is a quick way to assess this.) Mr Persaud was told about the exam and immediately resisted. Although he was held down, he managed to free one arm and punched a doctor. He fell unconscious after an injection and the examination proceeded.

When he woke up, Mr Persaud found that he had been handcuffed to the bed. He was arrested and taken in his hospital gown to be booked for assault. Now he is suing New York Presbyterian Hospital for assault, battery and false imprisonment. His lawyer claims that he has post-traumatic stress syndrome and cannot work as a result of his experience. The hospital counters that it will “vigorously contest” the lawsuit.

The case provoked a huge number of comments on a New York Times’s blog. A rectal exam is a standard ER procedure in such circumstances, emphasised some readers, although others maintained that alternative methods exist. Others observed that the staff may have thought that Mr Pernaud’s decision-making capacity had been impaired by his head injury. Others felt that paternalistic doctors were negligent in failing to obtain his informed consent. Now the court will have to decide. ~ New York Times, Jan 16; Women’s Bioethics Blog