NURS 501 Week 5 Case Studies Discussion 2, Canterbury v. Spence and Informed Consent Example

Case Studies Discussion 2: Disclosure, Consent and the Nurse at the Bedside

NURS 501 Health Policy and Ethics, Case Studies Discussion 2

Thread by [Student Name]

The classmates replied to are composites written for a model discussion.

Canterbury v. Spence is best known for changing what a physician must tell a patient, but the case actually raised two questions that matter to nurses: what information a patient is owed before consenting, and who is responsible when a patient is harmed while recovering. The federal appeals court in Washington, D.C., addressed both (Canterbury v. Spence, 1972).

The patient was a 19-year-old with severe back pain who underwent a laminectomy. He was not told that the operation carried a small risk of paralysis, which the surgeon later described as about one percent. The day after surgery he was allowed to get up to void without help, fell, and later developed paralysis. The trial court directed a verdict for the defendants, but the appeals court reversed. It held that the scope of disclosure depends on the information a person in the patient's position would treat as significant when deciding, so any risk material to that decision must be disclosed, not only what other physicians customarily mention. It also held that a jury should decide whether the hospital was negligent in letting the patient get up unattended (Canterbury v. Spence, 1972).

The reasonable patient standard moved consent from a doctor's habit to a patient's need. Mason et al. (2016) describe patient rights as shaped as much by policy and court decisions as by professional ethics, and this case is an example: hospital consent policies today assume the patient-centered standard it announced.

The research shows that disclosure alone is not the same as understanding. Glaser et al. (2020) reviewed 52 studies of interventions to improve comprehension in clinical informed consent. Compared with standard consent, comprehension improved in fewer than half of the written interventions but in all three studies that used a verbal discussion with test-feedback or teach-back. Jalal et al. (2024) reviewed 14 studies of tools for communicating statistical risk before surgery and found that seven of nine randomized trials showed better patient understanding of risk, although every trial had some quality concerns. A risk of one in a hundred is exactly the kind of number patients misremember, which makes these findings directly relevant to the Canterbury facts.

For the nurse, the lesson is twofold. When witnessing a consent, the nurse should ask the patient to explain the procedure and its main risks, and pause the process if the answer shows gaps. After surgery, the nurse's judgment about mobility and supervision is part of the patient's safety, as the court's second holding makes clear. Scripture describes the standard both duties rest on: "Lying lips are an abomination to the Lord, but those who act faithfully are his delight" (English Standard Version Bible, 2001/2016, Proverbs 12:22). Faithful disclosure is more than avoiding falsehood; it is making sure the truth was actually understood.

Reply to Jasmine

Jasmine, your point that the consent conversation often happens in a rushed preoperative bay is true on my unit as well, and I think your suggestion of a two-minute teach-back before the patient signs is realistic. There is good evidence that teach-back works even for patients who struggle most with health information. In a randomized trial of 84 women with low health literacy, Hosseinifar et al. (2024) found that three short teach-back sessions produced significantly higher breast cancer knowledge eight weeks later than usual education. The topic was screening rather than surgery, but the population is the one most likely to sign a consent form without understanding it. Asking a patient, "Tell me in your own words what could go wrong with this operation," takes very little time and gives the nurse a concrete reason to call the surgeon back when the answer is unclear. Paul urged the church to speak "the truth in love" (English Standard Version Bible, 2001/2016, Ephesians 4:15), and teach-back is one way of doing that: it checks that the truth arrived, and it does so gently. Does your preoperative area allow nurses to delay a case when a patient cannot explain the main risk? That policy question seems to me as important as the teaching itself.

Reply to Tyler

Tyler, you made an important distinction between witnessing a signature and confirming understanding, and I agree that many nurses believe their signature means more than it does. Legally, the witness usually attests that the patient signed voluntarily and appeared competent, not that the disclosure was adequate. However, the nurse is often the last professional to speak with the patient before the procedure, which makes the nurse well placed to notice confusion. Talevski et al. (2020), reviewing 20 studies of teach-back, found it effective in all but one and noted that it was usually delivered as part of a simple, structured approach, which suggests it can be added to the witness step without much training. Your idea of a short script on the back of the consent form for the witnessing nurse is a good one. James 1:19 advises believers to be "quick to hear, slow to speak" (English Standard Version Bible, 2001/2016), and a witness who listens to the patient's explanation, rather than reading the form aloud again, follows that counsel. Has your hospital's ethics committee ever reviewed what nurses are expected to do when a patient's answers show the consent was not truly informed?

References

Canterbury v. Spence, 464 F.2d 772 (D.C. Cir. 1972).

English Standard Version Bible. (2016). Crossway. (Original work published 2001)

Glaser, J., Nouri, S., Fernandez, A., Sudore, R. L., Schillinger, D., Klein-Fedyshin, M., & Schenker, Y. (2020). Interventions to improve patient comprehension in informed consent for medical and surgical procedures: An updated systematic review. Medical Decision Making, 40(2), 119-143. https://doi.org/10.1177/0272989X19896348

Hosseinifar, S., Afkhamzadeh, A., Moayeri, H., Ghaderi, S., & Mahmoodi, H. (2024). Teach back educational strategy on knowledge about breast cancer among low health literate women. BMC Medical Education, 24(1), Article 1420. https://doi.org/10.1186/s12909-024-06430-x

Jalal, A. H. B., Chatzopoulou, D., Marcus, H. J., & Pandit, A. S. (2024). Aids to improve understanding of statistical risk in patients consenting for surgery and interventional procedures: A systematic review. World Journal of Surgery, 48(4), 816-828. https://doi.org/10.1002/wjs.12142

Mason, D. J., Gardner, D. B., Outlaw, F. H., & O'Grady, E. T. (2016). Policy & politics in nursing and health care (7th ed.). Elsevier.

Talevski, J., Wong Shee, A., Rasmussen, B., Kemp, G., & Beauchamp, A. (2020). Teach-back: A systematic review of implementation and impacts. PLOS ONE, 15(4), Article e0231350. https://doi.org/10.1371/journal.pone.0231350