The ruling, by a federal appeals court in Washington in 1972, declared that before a patient provided informed consent to surgery or other proposed treatment, a doctor must disclose the risks, benefits and alternatives that a reasonable person would consider relevant.
Previously, the onus of soliciting that information had rested with the patient, and any description of risks was provided at the doctor’s discretion. A doctor had been considered negligent only when treatment was administered against the patient’s wishes.
“It would not be an exaggeration to say that the opinion is the cornerstone of the law of informed consent” to medical treatment, “not only in the United States, but in other English-speaking countries, too,” said Prof. Alan Meisel, who teaches law and psychiatry at the University of Pittsburgh School of Law.
The historical importance of his case was unbeknown to Mr. Canterbury and his family until about a decade ago, when Professor Meisel, who was researching the ruling, explained to them how it had benefited an untold number of subsequent patients.
For Mr. Canterbury, of course, it was, as Professor Meisel said, “the most Pyrrhic of victories.”
Jerry Watson Canterbury was born March 12, 1939, in Cyclone, W.Va., a hardscrabble hamlet in coal country near the Kentucky border. His father, Ott, was killed in a mining accident when Jerry was 9. He was raised by his widowed mother, the former Martha Morgan.
Like his two older brothers, Mr. Canterbury escaped Cyclone after graduating from high school, choosing not to risk a dangerous and perhaps fleeting job in the failing coal mines.
Rejected at a steel mill in Canton, he responded to an F.B.I. recruitment mailing, took a Greyhound bus 350 miles to Washington and was hired to work nights in the personnel records department as a clerk and messenger in January 1958.
The next December, after complaining of severe neck and back pain, he was referred to a prominent neurosurgeon, Dr. William T. Spence.
As Judge Spottswood W. Robinson III later wrote for the United States Court of Appeals for the District of Columbia Circuit in the case, Canterbury v. Spence, “The record we review tells a depressing tale.”
After undergoing a myelogram, in which dye is injected into the spinal column, Mr. Canterbury was told that he had a ruptured disk. Dr. Spence recommended a laminectomy, or decompression surgery, to relieve pressure on the spinal cord.
The day after the operation, Mr. Canterbury apparently fell out of bed trying to urinate. His legs became numb and he had difficulty breathing. He was rushed to emergency surgery.
He was discharged from the hospital three and a half months later, his legs partly paralyzed.
At first the F.B.I. accommodated his requests to be in a warmer climate or to be closer to his family. But after being transferred to Houston, he quit in 1962 and returned to Washington, where he worked briefly as a typist for National Geographic magazine before resigning because of depression.
He moved to Canton to be close to his siblings and his mother. In 1967, he was hired as a dispatcher in the Stark County Sheriff’s Office, a job he held for 20 years, much of it in a wheelchair, until his condition deteriorated and he became bed-bound.
By the time Mr. Canterbury’s five-year-old suit went to trial in 1968, his case was still fraught with questions. The one-year statute of limitations on battery — the legal charge for failing to get a patient’s consent to be treated — had expired, so the consent argument was included in a broader accusation of negligence.
But what constituted negligence? What caused his paralysis? His original condition? The surgery? His fall? The second operation? And did the doctor’s care differ from what another reasonable physician would have done?
In the middle of the trial, lawyers for Dr. Spence argued that Mr. Canterbury lacked the evidence to proceed. The judge agreed.
But the appeals court said the jury should have decided whether the doctor’s assurance, that the laminectomy was “no more serious than an ordinary, everyday operation,” should have included the caveat that 1 percent of those surgeries result in paralysis.
At a second trial, Dr. Spence acknowledged that he had informed Mr. Canterbury and his mother only that the surgery might result in “weakness,” not mentioning paralysis. He said he had not issued a more specific warning because it might have deterred the patient from needed surgery.
But the jury ruled against Mr. Canterbury, agreeing with the defense’s contention that he had in the meantime undermined his own credibility by consenting to another laminectomy. The jury did so “despite the fact that it was far more reasonable for Canterbury to accept the risk of paralysis the second time because he already was partially paralyzed,” Professor Meisel wrote in the book “Health Law & Bioethics: Cases in Context.”
Dr. Appel said the Canterbury case profoundly affected future litigation, well beyond broadening the definition of informed consent.
“The major legal implication of the decision,” he said, “was that it largely shifted our culture from a ‘professional practice standard’ to a ‘reasonable person standard’ in malpractice cases, undermined the tradition and practice of physicians not testifying against each other, and largely opened the floodgates to the far more litigious medicolegal culture we have today.”
Mr. Canterbury’s sister, Nancy Farahmand, said he died March 15 in Hartville, Ohio, and that the cause was complications of pulmonary disease. Besides her, he is survived by his brothers, Jack, James and John. A brief marriage in 1967 ended in divorce.
Ms. Farahmand recalled that her brother’s condition “cost him dearly physically, emotionally and financially, even though he received no compensation.”
But, she said in a phone interview, in his last years, the final 12 confined to his bed, he was comforted to know that his lawsuit and suffering had not been in vain.
“He was grateful to know that his case reinforced the fact we should all be adequately informed of the risks and benefits before we provide consent to medical procedures,” she said.
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