The role of informed consent for medical intervention in the investigation of legal cases against obstetrician-gynecologists

Spiridonov V.A., Kan N.E., Latfullina R.R., Tyutyunnik V.L.

1) Forensic Center of the Investigative Committee of the Russian Federation, Moscow, Russia; 2) Kazan State Medical University, Ministry of Health of Russia, Kazan, Russia; 3) Academician V.I. Kulakov National Medical Research Centre for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, Moscow, Russia; 4) I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia, Moscow, Russia

The article examines the patient’s informed consent for medical intervention as one of the fundamental legal principles of modern health care. The issues of providing information and obtaining patient’s informed consent for medical intervention in the routine practice of obstetrician-gynecologists are discussed. However, the proper level of information and consent for medical interventions is not always achieved and as a result, disagreements arise between patients and medical professionals, sometimes leading to the initiation of legal proceedings. Current legislation does not provide uniform requirements for the amount and format of information that an obstetrician-gynecologist must provide to a patient when performing a medical intervention. The development and adoption of universal standard forms of informed consent for medical interventions appear to be a necessary solution to this problem.
Conclusion: The development of the standard form can balance the rights of citizens to be informed when seeking medical assistance and protect doctors legally from patient claims by providing comprehensive and intelligible information. This is particularly important given that doctors may be held legally in case of violation of the informed consent rule. It should be noted that the acknowledgment of the potential risks associated with substandard medical care, as outlined in the informed consent for medical intervention, does not absolve the physician of legal responsibility. 

Authors’ contributions: Spiridonov V.A., Kan N.E., Latfullina R.R., Tyutyunnik V.L. – developing the concept and design of the study; search and analysis of the material; writing the text of the manuscript, editing the article.
Conflicts of interest: The authors declare that there are no conflicts of interest.
Funding: The study was carried out without sponsorship.
For citation: Spiridonov V.A., Kan N.E., Latfullina R.R., Tyutyunnik V.L. The role of informed consent for 
medical intervention in the investigation of legal cases against obstetrician-gynecologists.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2024; (12): 157-165 (in Russian)
 https://dx.doi.org/10.18565/aig.2024.139

Keywords

informed consent
obstetrics and gynecology
medical intervention
patient rights
lawsuits
cesarean section

References

  1. Центр судмедэкспертизы Минздрава раскрыл статистику по уголовным делам педиатров и акушеров. Доступно по: https://medvestnik.ru/content/news/Centr-sudmedekspertizy-Minzdrava-raskryl-statistiku-po-ugolovnym-delam-pediatrov-i-akusherov.html?utm_source=main&utm_medium=center-main-right (дата обращения: 10.05.2024). [The Center for Forensic Medicine of the Ministry of Health has disclosed statistics on criminal cases against pediatricians and obstetricians. Available at: https://medvestnik.ru/content/news/Centr-sudmedekspertizy-Minzdrava-raskryl-statistiku-po-ugolovnym-delam-pediatrov-i-akusherov.html?utm_source=main&utm_medium=center-main-right (accessed 05/10/2024) (in Russian)].
  2. Федеральный закон от 21.11.2011 N 323-ФЗ (ред. от 06.04.2015) «Об основах охраны здоровья граждан в Российской Федерации». Доступно по: https://www.consultant.ru/document/cons_doc_LAW_121895/ [Federal Law of November 21, 2011 N 323-FZ (as amended on April 6, 2015) «On the basics of protecting the health of citizens in the Russian Federation». Available at: https://www.consultant.ru/document/cons_doc_LAW_121895/ (in Russian)].
  3. Приказ Министерства здравоохранения РФ от 12 ноября 2021 г. N 1051н «Об утверждении Порядка дачи информированного добровольного согласия на медицинское вмешательство и отказа от медицинского вмешательства, формы информированного добровольного согласия на медицинское вмешательство и формы отказа от медицинского вмешательства». Доступно по: https://www.garant.ru/products/ipo/prime/doc/403011701/ [Order of the Ministry of Health of the Russian Federation of November 12, 2021 N 1051n «On approval of the Procedure for giving informed voluntary consent to medical intervention and refusal of medical intervention, forms of informed voluntary consent to medical intervention and forms of refusal of medical intervention». Available at: https://www.garant.ru/products/ipo/prime/doc/403011701/ (in Russian)].
  4. Федеральный закон от 25.12.2023 г. № 678-ФЗ (ред. от 25.12.2023 г.) «О внесении изменений в статью 20 Федерального Закона “Об основах охраны здоровья граждан в Российской Федерации”». Доступно по: https://www.consultant.ru/document/cons_doc_LAW_465621/ [Federal Law No. 678-FZ dated December 25, 2023 (as amended on December 25, 2023) «On amendments to Article 20 of the Federal Law “On the fundamentals of protecting the health of citizens in the Russian Federation”». Available at: https://www.consultant.ru/document/cons_doc_LAW_465621/ (in Russian)].
  5. Ревазова Е.А. Информированное добровольное согласие на медицинское вмешательство. Мониторинг правоприменения. Санкт-Петербургский государственный университет; 2021. Доступно по: https://pravoprim.spbu.ru/yurisprudentsiya/zashchitaprav-grazhdan/item/504-informirovannoe-dobrovolnoe-soglasie-na-meditsinskoe-vmeshatelstvo.html (дата обращения: 10.05.2024 г.). [Revazova E.A. Informed Voluntary Consent to Medical Intervention. Enforcement monitoring. St. Petersburg State University; 2021. Available at: https://pravoprim.spbu.ru/yurisprudentsiya/zashchitaprav-grazhdan/item/504-informirovannoe-dobrovolnoe-soglasie-na-meditsinskoe-vmeshatelstvo.html (accessed 05.10.2024). (in Russian)].
  6. Приказ Министерства здравоохранения РФ от 7 апреля 2016 г. № 216н «Об утверждении формы информированного добровольного согласия на проведение искусственного прерывания беременности по желанию женщины». Доступно по: https://www.garant.ru/products/ipo/prime/doc/71291892/ [On approval of the form of informed voluntary consent for artificial termination of pregnancy at the request of a woman: Order of the Ministry of Health of the Russian Federation of April 7, 2016 No. 216n. Available at: https://www.garant.ru/products/ipo/prime/doc/71291892/ (in Russian)].
  7. Сметанин А.В. Юридические аспекты информированного добровольного согласия. Доступно по: https://endovascular.ru/upload/files/documents/Юридические%20аспекты%20информированного%20добровольного%20согласия-1.pdf (дата обращения: 10.05.2024 г.). [Smetanin A.V. Legal aspects of informed voluntary consent. Available at: https://endovascular.ru/upload/files/documents/Юридические%20аспекты%20информированного%20добровольного%20согласия-1.pdf (accessed 10.05.2024)(in Russian)].
  8. Закон Российской Федерации «О защите прав потребителей» от 07.02.1992 г. № 2300-1 (ред. от 11.06.2021 г.). Российская газета, № 8, 16.01.1996. [Law of the Russian Federation «On the Protection of Consumer Rights» dated 02.07.1992. No. 2300-1 (as amended on 06.11.2021). Rossiyskaya Gazeta, No. 8, 01.16.1996. (in Russian)].
  9. Постановление Пленума Верховного Суда РФ от 28 июня 2012 г. № 17 «О рассмотрении судами гражданских дел по спорам о защите прав потребителей». Доступно по: https://www.consultant.ru/document/cons_doc_LAW_131885/ [Resolution of the Plenum of the Supreme Court of the Russian Federation dated June 28, 2012 No. 17 «On the consideration by courts of civil cases in disputes regarding the protection of consumer rights». Available at: https://www.consultant.ru/document/cons_doc_LAW_131885/ (in Russian)].
  10. Кодекс об административных правонарушениях (ред. от 16.04.2022). Собрание законодательства Российской Федерации. 2001, №195. [Code of Administrative Offenses (as amended on April 16, 2022). Collection of Legislation of the Russian Federation. 2001, No. 195. (in Russian)].
  11. Постановление Правительства РФ от 11 мая 2023 г. № 736 «Об утверждении Правил предоставления медицинскими организациями платных медицинских услуг, внесении изменений в некоторые акты Правительства Российской Федерации и признании утратившим силу постановления Правительства Российской Федерации от 4 октября 2012 г. № 1006». Доступно по: http://government.ru/docs/all/147526/ [Decree of the Government of the Russian Federation of May 11, 2023 No. 736 «On approval of the Rules for the provision of paid medical services by medical organizations, amendments to some acts of the Government of the Russian Federation and invalidation of Decree of the Government of the Russian Federation of October 4, 2012 No. 1006». Available at: http://government.ru/docs/all/147526/(in Russian)].
  12. Гражданский кодекс Российской Федерации (часть первая): от 30.11.1994 № 51-ФЗ (ред. от 11.03.2024). Собрание законодательства РФ. 05.12.1994; № 32: Cт. 3301. [Civil Code of the Russian Federation (part one): dated November 30, 1994 No. 51-FZ (as amended on March 11, 2024). Collection of Legislation of the Russian Federation. 05.12.1994; No. 32: Art. 3301.(in Russian)].
  13. Приказ Министерства здравоохранения и социального развития РФ от 24.04.2008 г. № 194н «Об утверждении Медицинских критериев определения степени тяжести вреда, причиненного здоровью человека». Российская газета. 2008, № 188. [Order of the Ministry of Health and Social Development of the Russian Federation dated April 24, 2008 No. 194n «On approval of Medical criteria for determining the severity of harm caused to human health». Rossiyskaya Gazeta. 2008, No. 188. (in Russian)].
  14. Weiser T.G., Haynes A.B., Molina G., Lipsitz S.R., Esquivel M.M., Uribe-Leitz T. et al. Size and distribution of the global volume of surgery in 2012. Bull. World Health Organ. 2016; 94(3): 201-209F. https://dx.doi.org/10.2471/BLT.15.159293.
  15. Teshome M., Wolde Z., Gedefaw A., Tariku M., Asefa A. Surgical informed consent in obstetric and gynecologic surgeries: experience from a comprehensive teaching hospital in Southern Ethiopia. BMC Med. Ethics. 2018; 19(1): 38. https://dx.doi.org/10.1186/s12910-018-0293-2.
  16. Kotaska A. Informed consent and refusal in obstetrics: A practical ethical guide. Birth. 2017; 44(3): 195-9. https://dx.doi.org/10.1111/birt.12281.
  17. Bakker W., Zethof S., Nansongole F., Kilowe K., van Roosmalen J., van den Akker T. Health workers' perspectives on informed consent for caesarean section in Southern Malawi. BMC Med. Ethics. 2021; 22(1): 33. https://dx.doi.org/ 10.1186/s12910-021-00584-9.
  18. Ogunbode O.O., Oketona O.T., Bello F.A. Informed consent for caesarean section at a Nigerian university teaching hospital: patients’ perspective. Trop. J. Obstet. Gynaecol. 2015; 32(1): 55-63.
  19. Wolf J.H. Risk and reputation: obstetricians, cesareans, and consent. J. Hist. Med. Allied Sci. 2018; 73(1): 7-28. https://dx.doi.org/10.1093/jhmas/jrx053.
  20. Weaver J.J., Statham H., Richards M. Are there «unnecessary» cesarean sections? Perceptions of women and obstetricians about cesarean sections for nonclinical indications. Birth. 2007; 34(1): 32-41. https://dx.doi.org/10.1111/j.1523-536X.2006.00144.x.
  21. Lescale K.B., Inglis S.R., Eddleman K.A., Peeper E.Q., Chervenak F.A., McCullough L.B. Conflicts between physicians and patients in non-elective cesarean delivery: incidence and the adequacy of informed consent. Am. J. Perinatol. 1996; 13(3): 171-6. https://dx.doi.org/10.1055/s-2007-994319.
  22. Chervenak F.A., McCullough L.B. Clinical guides to preventing ethical conflicts between pregnant women and their physicians. Am. J. Obstet. Gynecol. 1990; 162(2): 303-7. https://dx.doi.org/10.1016/0002-9378(90)90374-g.
  23. Simoes E., Kunz S.K., Münnich R., Schmah F.W. Informed Consent bei der Entscheidung zum Kaiserschnitt – methodenbezogene Morbiditätsgradienten erfordern die Befähigung der Schwangeren. Geburtshilfe und Frauenheilkunde. 2010; 70(09): 732-8. https://dx.doi.org/10.1055/s-0030-1250306.
  24. Deutsche Gesellschaft für Gynäkologie und Geburtshilfe (DGGG). Arbeitsgemeinschaft Medizinrecht (AG MedR). DGGG-Leitlinie: Absolute und relative Indikationen zur Sectio caesarea und zur Frage der sogenannten Sectio auf Wunsch. Im Internet: http://leitlinien.net/; Stand: 3. 6. 2010.
  25. Gesetz zur Verbesserung der Rechte von Patientinnen und Patienten (Paragraf). Deutscher Bundestag. Available at: https://dip.bundestag.de/vorgang/gesetz-zur-verbesserung-der-rechte-von-patientinnen-und-patienten/45245 (дата обращения: 10.05.2024).
  26. § 1827 BGB – Patientenverfügung; Behandlungswünsche oder mutmaßlicher Wille des Betreuten (Paragraf). Rechtsanwalt und Sozialrecht.Available at: https://rechtsanwalt-und-sozialrecht.de/tag/%C2%A7-1827-bgb/ (дата обращения: 10.05.2024).
  27. Nicholls J., David A.L., Iskaros J., Lanceley A. Consent in prengnancy: a qualitative study of the views and experiences of women and their healthcare professionals. Eur. J. Obstet. Gynecol. Reprod. Biol. 2019; 238: 132-7. https://dx.doi.org/10.1016/j.ejogrb.2019.05.008.
  28. Panda S., Begley C., Daly D. Clinicians’ views of factors influencing decision-making for caesarean section: a systematic review and metasynthesis of qualitative, quantitative and mixed methods studies. PLoS One. 2018; 13(7): e0200941. https://dx.doi.org/10.1371/journal.pone.0200941.
  29. Convie L.J., Carson E., McCusker D., McCain R.S., McKinley N., Campbell W.J. et al. The patient and clinician experi- ence of informed consent for surgery: a systematic review of the qualitative evidence. BMC Med. Ethics. 2020; 21(1): 58. https://dx.doi.org/10.1186/s12910-020-00501-6.
  30. Betschart P., Zumstein V., Hasan Ali O., Schmid H.P., Abt D. Readability Assessment of Patient Education Material Published by German­Speaking Associations of Urology. Urol. Int. 2018; 100(1): 79-84. https://dx.doi.org/10.1159/000480095.
  31. Tegethoff D. Lesbarkeit von Informationsmaterial in der Geburtshilfe [Readability of Information Material in Obstetrics]. Z. Geburtshilfe Neonatol. 2020; 224(4): 208-16. German. https://dx.doi.org/10.1055/a-1014-3619.
  32. Jütte R. Aufklärung und informed consent. Deutsches Ärzteblatt. 2018; 115(27-28): A-1324 / B-1120 / C-1112.
  33. Whitney S.N., McGuire A.L., McCullough L.B. A typology of shared decision making, informed consent, and simple consent. Ann. Intern. Med. 2004; 140(1): 54-9. https://dx.doi.org/10.7326/0003-4819-140-1-200401060-00012.
  34. Teubel A. Arzthaftungsrecht: Aufklären, aber richtig. Deutsches Ärzteblatt. 2010; 107(19): A-951 / B-831 / C-819.
  35. Трегубов С.Н. Уголовная ответственность врача за врачевание без согласия больного: Доклад, прочитанный в заседании Уголовного отделения Юридического общества при Санкт-Петербургском университете и напечатанный в Журнале Министерства юстиции. Санкт-Петербург: Сенат. тип.; 1904. [Tregubov S.N. Criminal liability of a doctor for treating without the consent of the patient: A report read at a meeting of the Criminal Division of the Law Society at St. Petersburg University and printed in the Journal of the Ministry of Justice. St. Petersburg: Senate. typ.; 1904. (in Russian)].
  36. Библиотека судебных процессов. Дело доктора Модлинского. Совершение операции без согласия больного. Российская государственная бибилиотека. Доступно по: https://viewer.rsl.ru/ru/rsl01003712124?page=1&rotate=0&theme=white (дата обращения 10.05.2024 г.). [Litigation Library. The case of Dr. Modlinsky. Performing an operation without the patient’s consent. Russian State Library. Available at: https://viewer.rsl.ru/ru/rsl01003712124?page=1&rotate=0&theme=white (accessed 05/10/2024).(in Russian)].
  37. Ширяев В.Н. Уголовная ответственность врачей. СПб.: Н.К. Мартынов; 1903. 48 с. [Shiryaev V.N. Criminal liability of doctors. St. Petersburg: N.K. Martynov; 1903. 48 p. (in Russian)].
  38. Ширяев В.Н. Врачебная деятельность и уголовное право. Журнал Министерства Юстиции. СПб. 1902; 5: 46-71. [Shiryaev V.N. Medical practice and criminal law. Journal of the Ministry of Justice. St. Petersburg. 1902; 5: 46-71. (in Russian)].
  39. Нейштубе П.Т. Ответственность врача-акушера перед судом совести и уголовным законом: [Речь, произнесенная (in extenso) на заключительном собрании 2 Акушерско-гинекологического съезда в Киеве]. Д-р мед. П.Т. Нейштубе. Киев: скоропеч. Ш. Абтихеса, 1910; 2: 16 с; 25. [Neishtube P.T. Responsibility of an obstetrician before the court of conscience and criminal law: [Speech delivered (in extenso) at the final meeting of the 2nd Obstetric and Gynecological Congress in Kyiv]. Dr. Med. P.T. Neishtube. Kyiv: Sh. Abtikhes quick-print; 1910; 2: 16 s; 25. (in Russian)].
  40. Кралько А.А. Медико-правовые аспекты получения информированного согласия на медицинское вмешательство. Департамент исполнения наказаний МВД Республики Беларусь. Медицинские новости. 2009; 12: 41-5. [Kralko A.A. Medico-legal aspects of obtaining informed consent for medical intervention. Department of Execution of Punishments of the Ministry of Internal Affairs of the Republic of Belarus. Medical news. 2009; 12: 41-5.(in Russian)].
  41. Уголовный кодекс Российской Федерации (ред. от 25.03.2022). Собрание законодательства Росссийской Федерации. 1996; № 25: Cт. 2954. [Criminal Code of the Russian Federation (as amended on March 25, 2022). Collection of Legislation of the Russian Federation. 1996; No. 25: Art. 2954. (in Russian)].
  42. Уголовно-процессуальный кодекс Российской Федерации (ред. от 25.03.2022). Собрание законодательства Российской Федерации. 2001; №52: Ст. 4921. [Criminal Procedure Code of the Russian Federation (as amended on March 25, 2022). Collection of Legislation of the Russian Federation. 2001; No. 52: Art. 4921. (in Russian)].
  43. Постановление № 1-60/2021 от 9 марта 2021 г. по делу № 1-60/2021 г. [Resolution No. 1-60/2021 of March 9, 2021 in case No. 1-60/2021.(in Russian)].
  44. Решение по делу №2-99/2023 от 13 марта 2023 г. Дело № 2-99/2023 г. [Decision in case No. 2-99/2023 dated March 13, 2023. Case No. 2-99/2023. (in Russian)].
  45. Дубовая Е.Г., Онищенко Е.Ф. Правовые основы защиты репутации врача и медицинской организации в России. Акушерство и гинекология. 2020; 4 (Приложение): 83-5. [Dubovaya E.G., Onishchenko E.F. Legal basis for protecting the reputation of a doctor and a medical organization in Russia. Obstetrics and Gynecology. 2020; 4 (Suppl.): 83-5. (in Russian)].

Received 10.06.2024

Accepted 12.12.2024

About the Authors

Valeriy A. Spiridonov, Professor, Dr. Med. Sci., Head of Forensic Research Department, Forensic Expert Center of the Investigative Committee of the Russian Federation, 119311, Russia, Moscow, Stroiteley str., 8, build. 2; Professor at the Department of Forensic Medicine, Kazan State Medical University, Ministry of Health of Russia,
420012, Russia, Volga Federal District, Republic of Tatarstan, Kazan, Butlerov str., 49, +7(843)236-06-52, vaspiridonov@yahoo.com, https://orcid.org/0000-0003-4004-8482
Natalia E. Kan, Professor, Dr. Med. Sci., Deputy Director of Science, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, 117997, Russia, Moscow, Ac. Oparin str., 4, +7(926)220-86-55, kan-med@mail.ru, Researcher ID: B-2370-2015, SPIN: 5378-8437, Authors ID: 624900, Scopus Author ID: 57008835600, https://orcid.org/0000-0001-5087-5946
Raina R. Latfullina, PhD student, I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University),
119991, Russia, Moscow, Trubetskaya str., 8, build. 2, +7(495)609-14-00, latfullina1997@mail.ru, https://orcid.org/0000-0001-9053-9453
Victor L. Tyutyunnik, Professor, Dr. Med. Sci., Leading Researcher at the Center for Scientific and Clinical Research, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of the Russia, 117997, Russia, Moscow, Ac. Oparin str., 4, +7(903)969-50-41, tioutiounnik@mail.ru, Researcher ID: B-2364-2015, SPIN: 1963-1359, Authors ID: 213217, Scopus Author ID: 56190621500, https://orcid.org/0000-0002-5830-5099
Corresponding author: Valeriy A. Spiridonov, vaspiridonov@yahoo.com

Similar Articles

By continuing to use our site, you consent to the processing of cookies that ensure the proper functioning of the site.