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We’re thrilled to welcome well-known quality and safety authority Michael Millenson as the newest member of the Society for Participatory Medicine. Here is his first guest post, referring back to his popular article in our Journal. He illustrates how recently the patient’s opinion counted for nothing, citing two horrible stories that were just a century ago.

There is a grim reminder in a recent issue of The New Yorker on just how far we’ve come in the patient rights movement and, for that matter, the women’s rights movement. It’s an aside about a young life needlessly lost, just one line in a long article about John Lewis Gaddis’ new bookGeorge Kennan: An American Life, a biography of the famous Cold War-era foreign affairs expert. To understand why the line resonates, however, you have to know a brief snippet of buried medico-legal history.

As I wrote in the Society’s journal in a June, 2011 article, Spock, Feminists and the Fight for Participatory Medicine, it took a court decision to establish that a doctor must tell the patient what operation he is doing in advance of actually doing it. One landmark case, decided at the start of the 20th century, involved 40-year-old Parmelia Davis, an epileptic whose surgeon removed her uterus and ovaries without informing Davis of his intentions. I wrote:

In the best tradition of “caring custody,” the surgeon later explained he had deceived his patient so she would not refuse the operation. Unless the patient expressly limits what the doctor can do, the surgeon’s attorneys argued, “she thereby in law consents that he may perform such operation as in his best judgment is proper and essential to her welfare. In a 1905 opinion, the Court declared that Americans’ rights as free citizens prohibited “a physician or surgeon, however skillful or eminent…to violate without permission the bodily integrity of his patient…and [to operate] on him without his consent or knowledge.”

What I did not write was that part of the doctor’s defense was that he’d told Davis’s husband about the procedure and gotten his consent. (The conversation was disputed.)

Now, returning to The New Yorker article, flash forward to the death of Kennan’s mother when he was just two months old, from peritonitis resulting from a ruptured appendix. The article notes:

The story, which Gaddis does not repeat, is that the doctors refused to operate without permission from her husband, who was away on a fishing trip.

George Kennan was born in Milwaukee in 1904, before the ruling mentioned above and similar ones a few years later. He grew up never knowing his mother because of a legally sanctioned crude view about the status of women that trumped common sense and what most of us would presume to be basic medical ethics.

Yes, we’ve come a long way, baby, but those who fight for patient rights and/or women’s rights would do well to remember how recent that progress is and how fragile it still might be.



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