ertise of the operating team and any of a number of unforeseen difficulties.
Nothing about the pressures of on-the-line patient-doctor interaction and the need for a doctor--even one who is member of an operating team rather than the chief surgeon in a given case--to foster patient confidence relieves knowledgeable medical practitioners from the obligation to provide patients with adequate information to make an informed decision about their care. Nor do such pressures as a matter of fact necessarily conflict with the patient's entitlement to informed consent. Whether that information needs to come from a physician, nurse, or hospital administration is the problematic feature of informed consent. It is difficult to see why, as a practical matter, any hospital administrator or practitioner on the whole confident that hospital staff could produce favorable outcomes should be reluctant to share with patients the facts of organizational policy. It is also difficult to see where any ethical dilemma arises where the issue of articulating standard policy is concerned, if competence and an ethic of patient care in general are in the background of the policy whether articulated or not.
The problem for hospital administration in Widener's case was created by the cardiologist's evasiveness on the question of who was going to do the surgical procedure. The effect of that evasiveness was to create an administrative headache (not nightmare, thanks to the success of the surgery). It seems reasonable to infer that implicit in the cardiologist's evasion is the opportunity cost of having to explain to the patient the teaching hospital's policy of allowing residents to do work that might otherwise be done by a fully qualified surgeon. Equally, admitting that a resident and not the cardiologist was going to do the work might have led to (say) a request for a discount or a request for a different doctor and hospital altogether. In other words, at the ...