Kennedy v. Parrott
243 N.C. 355, 56 A.L.R. 2d 686, 90 S.E.2d 754 (1956)
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Rule of Law:
In major internal operations, a patient's consent will be construed as general in nature, authorizing the surgeon to remedy any abnormal or diseased condition discovered in the area of the original incision if sound professional judgment dictates it is necessary, especially when the patient is unconscious and unable to give express consent.
Facts:
- Plaintiff consulted defendant, a surgeon, for treatment for an ailment.
- Defendant agreed to perform an appendectomy on the plaintiff.
- Plaintiff was placed under general anesthesia for the operation.
- During the appendectomy, the defendant discovered some enlarged follicle cysts on the plaintiff's ovaries.
- The defendant, exercising his professional judgment that the cysts were potentially dangerous, punctured them.
- Plaintiff had not given express consent for the defendant to perform any procedure on her ovaries.
- After the operation, plaintiff developed phlebitis in her leg.
Procedural Posture:
- Plaintiff filed a lawsuit against the defendant surgeon in a trial court, seeking damages for personal injury.
- The complaint alleged negligence and an unauthorized operation constituting a technical assault or trespass.
- At the conclusion of all the evidence at trial, the court granted the defendant’s motion for a judgment of nonsuit, dismissing the plaintiff's case.
- Plaintiff appealed the judgment of nonsuit to the state's highest court.
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Issue:
Does a surgeon commit an unauthorized trespass or battery by extending a consented-to internal operation to remedy a newly discovered, potentially dangerous condition in the immediate area of the incision, when the patient is under anesthesia and unable to give express consent?
Opinions:
Majority - Barnhill, C. J.
No. A surgeon does not commit an unauthorized trespass or battery by extending an operation under these circumstances because the patient’s consent is construed as general in nature. The court reasoned that the common law rule requiring express consent for any surgical extension is outdated and impractical in the age of modern surgery and anesthesia. When a patient is unconscious, they cannot provide consent at the very moment a complete diagnosis is often made—after the incision. The law must adapt to these changed conditions, implying that the patient's consent extends to remedying any abnormal conditions found within the surgical area when the surgeon, in their sound professional judgment, deems it necessary for the patient's welfare. It would be unreasonable to require a surgeon to halt an operation to obtain consent for a simple, necessary extension when the patient is unconscious and the potential danger is evident.
Analysis:
This decision represents a significant evolution in the doctrine of medical consent, moving away from the rigid common law requirement of specific consent for every procedure. It establishes a more flexible standard of implied or general consent for internal operations, granting surgeons the discretion to address unforeseen conditions discovered during surgery. This precedent protects surgeons from liability for battery when acting in the patient's best interest based on sound medical judgment, thereby balancing the principle of patient autonomy with the practical realities of modern surgical practice. The ruling prioritizes patient welfare and medical reasonableness over a strict, and often impractical, application of consent rules.
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