Informed Consent: A Surgeon’s Strongest Legal Tool Against Malpractice
A scalpel might save a life. But a conversation between a doctor and a patient—clear, candid, and properly documented—saves a medical practitioner’s life or career. In the sterile world of operating rooms and legal briefs, few things cut as sharply as informed consent.
It began, as these stories often do, with a consent form and a signature.
A man with an aortic aneurysm was scheduled for a stenting procedure. His surgeon walked him through the risks and his options. He agreed and signed the consent forms. Stenting proved unsuccessful. Days later, he died. The family mourned and, thereafter, lodged a malpractice suit.
This is a short-hand retelling of the case of Que v. Philippine Heart Center, G.R. No. 268308, April 02, 2025. A legal battle that reached its final verdict 25 years after the patient’s death.
The crux of the case lay in a fundamental, but often overlooked, concept in legal medicine: informed consent. In Que, the Philippine Supreme Court reaffirmed one of the most powerful legal doctrines in medicine: informed consent, when rightfully obtained, is sharper than any scalpel.
In a nutshell, the Supreme Court cleared the physician because he fulfilled his duty to explain, inform, and document consent. In the words of the Supreme Court:
“The facts would show that Dr. Aventura informed the Que family, most especially Quintin, of the material risks inherent in the stenting procedure, and that includes death.”
The records show that the patient signed the Consent for Endovascular Stenting and the Consent to Operation, Administration of Anesthesia, and the Rendering of Other Medical Services. His signature appeared in these documents, and this was never questioned.
When tragedy strikes, the conversation between a physician and a patient isn’t just a formality—it becomes evidence, a lifeline in a murky sea of legal scrutiny. The doctrine is not about absolving doctors of blame; it’s about ensuring clarity, mutual understanding, and trust between the caregiver and the cared for.
By no means does the case state that signing a consent is a carte blanche excuse for negligence or malpractice. Malpractice needs to be proven with hard evidence unless it falls under the doctrine of res ipsa loquitur.
Lessons from the courtroom to the operating room
In an overstretched healthcare system, where one physician may be responsible for dozens of patients on any given shift, the ritual of informed consent often collapses into routine. Doctors and nurses, pressed for time, may move robotically through the process: handing over forms that are signed, but not truly understood.
Yes, the paperwork is there. But the information? Often absent.
This is the uneasy paradox at the heart of Philippine hospitals: consent is technically obtained, but substantively hollow. In too many cases, the signature becomes a substitute for the conversation. I have seen this firsthand.
What Que forces us to confront is a powerful truth: informed consent is not merely about protecting the physician or the institution—it’s about empowering the patient. The importance of informed consent resonates as a beacon of communication, one rooted not merely in paperwork but in the human connection that defines caring at its core.
As a lecturer on nursing ethics and legal medicine, I often emphasized a framework first outlined by bioethicists Beauchamp and Childress (2013). This model dissects consent into three pivotal stages: threshold, information, and consent.
This framework is based on the model proposed by Beauchamp and Childress, as cited by the Berman Institute of Bioethics, Johns Hopkins University. (Source: Beauchamp TL, Childress JF. Meaning and Elements of Informed Consent. Berman Institute of Bioethics, Johns Hopkins University. https://bioethics.jhu.edu)
Elements of Informed Consent
Threshold elements serve as the foundational preconditions for informed consent, ensuring that the patient is both capable of making decisions and free from undue influence. A medical practitioner should ascertain the patient’s competence and the voluntariness of decision-making.
Competence refers to the patient’s ability to understand medical information, evaluate options, and make informed decisions. Competence is not merely a legal concept but also a practical one, requiring healthcare providers to evaluate whether the patient has the cognitive and emotional capacity to grasp the implications of their choices.
Voluntariness, on the other hand, underscores the importance of a patient's decision being made free from coercion, manipulation, or external pressures. Whether the influence comes from family members, medical staff, or societal expectations, voluntariness ensures that the patient’s autonomy and personal agency are respected in the decision-making process.
Information elements are crucial to the process of informed consent, ensuring that patients are provided with sufficient details to make a knowledgeable decision regarding their medical care. They include:
Disclosure or the sharing of all material information that a patient needs to understand the medical procedure, including its purpose, benefits, risks, and potential alternatives.
Recommendation that goes a step beyond disclosure by providing the physician's professional opinion on the best course of action. While laying out all the possible scenarios, a healthcare provider must guide the patient toward an informed choice by interpreting the medical data and suggesting a preferred plan.
Understanding -- the final, pivotal component of the information elements– that ensures that the patient not only hears the information but also comprehends it fully. This stage might involve confirming the patient's grasp of the disclosed risks, benefits, and alternatives by engaging them in dialogue, answering their questions, and clarifying any uncertainties. The focus here is to ensure that the patient is genuinely aware and capable of making an informed decision.
Consent elements are essential to completing the process of informed consent and represent the final stage of patient decision-making. They comprise two critical components:
A decision that involves the patient's active choice in favor of a proposed plan or procedure. It is the moment in which the patient exercises their autonomy to determine what they believe to be the best course of action for their health.
Authorization, which marks the formal agreement to proceed with the chosen plan, serves as the confirmation that the patient has willingly provided consent, free from coercion or undue influence. It often involves a signed consent form.
Together, these elements affirm the patient's role as an active participant in their healthcare journey, underscoring the importance of respect, transparency, and ethical practice in medical decision-making.
While the importance of informed consent had been highlighted in earlier precedents, Que serves as a definitive example of the critical importance of informed consent, underscoring its role as a cornerstone of legally sound medical practice.
When tragedy strikes, as it did in this case, consent becomes the anchor that steadies a physician in the storm of loss and litigation, while serving as a testament to the patient’s agency in their own care.
This doctrine, affirmed by the Philippine Supreme Court, should echo in every hospital corridor, every operating room, and every medical school lecture. It demands a rethinking of how we view conversations between doctors and patients—not as perfunctory exchanges, but as critical lifelines, ensuring that medicine remains rooted in the very humanity it seeks to preserve.
No one expects doctors to be insurers of lives. But they are expected to ensure that patients understand the risks in the course of treatment. That means, doctors must exert efforts to:
Speak plainly, not just professionally.
Disclose the full range of risks, including death or disability.
Respect the silence between questions. Listen to what the patient is not saying.
Record the consent not just with ink, but with intention.
The law won’t punish honest medicine. But it does demand transparent communication.
Where is the nurse in all of this?
As a former professor of legal aspects in nursing, I often posed a critical question to my students during case discussions on medical malpractice: where is the nurse in all of this?
It’s a common misconception that nurses secure consent. Legally, that’s the physician’s role. But nurses play a quiet, indispensable one: they advocate. The nursing duty is subtle, but powerful:
Observe whether the patient appears to fully understand the procedure.
Notice verbal and non-verbal cues—hesitation, confusion, fear.
Record any clarifications the patient requests.
Raise concerns to the attending physician before the procedure proceeds.
In healthcare, nurses hold a role less visible but no less vital: ensuring patients are not adrift in uncertainty. While they do not explain the intricacies of medical procedures—that responsibility rests firmly with physicians—they serve as the guardians of comprehension and clarity. Their duty extends beyond care to meticulous documentation, as underscored by the Nursing Code of Ethics for Filipino Nurses: “Accurate documentation of actions and outcomes of delivered care is the hallmark of nursing accountability.” [Article III, Section 6 (3), Board of Nursing Resolution No. 220, s. 2004]. Through this quiet vigilance, nurses stand as the system’s conscience, ensuring every patient’s dignity remains intact.
“Accurate documentation of actions and outcomes of delivered care is the hallmark of nursing accountability.”
What they witness in the hallway or at the bedside may later shape a courtroom’s view of what happened. Nurses aren’t passive bystanders. They are the system’s pulse-check. And when they speak up, they often speak for those who can’t.
Final cut: why consent still matters
Informed consent is not just a line on a checklist. It’s a promise—a small but vital act of dignity in a system that often forgets how human medicine truly is.
When done right, it empowers the patient. It protects the professional. It restores faith in a process that too often collapses into litigation and blame.
The sharpest tool in healthcare isn’t a scalpel. It’s the truth, told clearly, before the first cut.
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