Understanding Informed Consent in Medical Cases

I. Introduction

The Supreme Court’s decision in Elpidio Que v. Philippine Heart Center et al. crystallizes two pillars of medical malpractice jurisprudence in the Philippines: the precise contours of the “standard of care” and the exacting demands of informed consent. By denying the petition of the Que family and absolving Dr. Adventura of liability, the Court reaffirms that procedural rigor both in diagnosis and communication can insulate a practitioner from charges of negligence, even when a patient’s outcome is tragically adverse.

II. Factual and Procedural Synopsis

• In mid-1999, Quintin Que was diagnosed with a coronary aneurysm. Dr. Adventura, then Head of Surgery at the Philippine Heart Center, performed a three-vessel coronary-artery bypass.
• In October 1999, the physician proposed a cutting-edge stenting procedure, described to the family as “virtually risk-free.” The family provided written consent.
• On February 14, 2000, under the hands of a visiting Belgian specialist, Mr. Que underwent stenting. He never regained consciousness and succumbed to a catheter-induced stroke on February 27, 2000.
• The trial court and the Court of Appeals dismissed the Que family’s malpractice suit for failure to establish duty-breach causation. The family’s petition was filed with the Supreme Court.

III. Doctrinal Foundations

1. Standard of Care
   Medical malpractice is, at its core, negligence. Under Cayao-Lasam v. Spouses Ramolete, the duty of care is measured against what “ordinarily trained medical professionals” would do under like circumstances. Absent proof of deviation from accepted medical practice, adverse outcomes even fatal ones do not, ipso facto, establish liability.
2. Informed Consent
   Rooted in Schoendorff v. Society of New York Hospital and refined in Canterbury v. Spence, the doctrine mandates that physicians disclose all “material risks” those a reasonable patient would deem significant in clear, nontechnical language. Consent must be both knowing and voluntary; any material omission that, had it been disclosed, might have altered the patient’s decision will vitiate the practitioner’s defense against liability.

IV. Court’s Reasoning

1. Duty and Breach
   The Court examined the consent record and corroborating affidavits. Dr. Adventura’s notes and the family’s signed consent form explicitly referred to the small but real risk of death. By documenting these discussions at the time of care, the physician satisfied the disclosure mandate and thus breached no duty.

2. Causation
   The fatal stroke was traced not to negligent catheter manipulation but to an inherent biomechanical risk of any endovascular intervention. Expert testimony confirmed that the complication rate for such strokes though low falls within the known risk profile of stenting. Because the adverse event lay within the ambit of disclosed risks, causation of harm by negligence was deemed absent.

VI. Practical Implications

1. Enhanced Consent Protocols
   • Use standardized checklists that itemize even rare and serious complications.
   • Use plain-language summaries and visual aids to reinforce verbal explanations.
2. Robust Medical Records
   • Record not only what risks were disclosed but also the patient’s questions and responses.
   • Timestamp and initial each entry immediately after the discussion.
3. Ongoing Professional Development
   • Train clinicians in communication skills, emphasizing empathy and clarity.
   • Conduct periodic audits of consent practices to identify gaps in patient understanding.

VII. Conclusion

Elpidio Que v. Philippine Heart Center delivers a clear message that is technical proficiency must be matched by meticulous communication. Ultimately, the ruling advances a dual objective: protecting patients without freezing the evolution of medical practice.

Sources: G.R. No. 268308 (Supreme Court)