Sinclair by Sinclair v. Block
633 A.2d 1137, 1993 Pa. LEXIS 243, 534 Pa. 563 (1993)
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Rule of Law:
A physician's use of forceps to assist in a natural childbirth is not a distinct surgical or operative procedure that requires specific informed consent. The doctrine of informed consent does not apply to the natural delivery process because it is an inevitable event over which the patient has no choice to halt or remain in their present condition.
Facts:
- In 1981, Joan Sinclair became pregnant and sought prenatal care from Dr. Block.
- During a visit, Mrs. Sinclair signed a general consent form for "prenatal care, delivery care, postnatal care and/or caesarian section."
- Mrs. Sinclair was not verbally or in writing informed that forceps might be used during delivery.
- In October 1982, during labor, Mrs. Sinclair's cervix fully dilated but the baby's movement through the birth canal ceased, a condition known as "arrest of descent."
- Dr. Block observed the baby was in a transverse position and the baby's heart rate had slowed.
- Dr. Block attempted to use forceps to rotate the baby and assist with the delivery.
- The forceps attempt failed, and the baby, Paula Sinclair, was ultimately delivered via Caesarian section.
- After birth, Paula was found to have a fractured skull and seizures, along with swelling and a mark on her head alleged to be from the forceps.
Procedural Posture:
- The Sinclair family sued Dr. Block and his employer, Philadelphia OB-GYN Group, Ltd., in the Court of Common Pleas (the trial court).
- The trial court entered a compulsory nonsuit in favor of the defendants on the informed consent claim.
- A jury rendered a verdict in favor of the defendants on the separate negligence claim.
- The trial court denied the Sinclairs' post-trial motions.
- The Sinclairs (as appellants) appealed to the Superior Court of Pennsylvania, an intermediate appellate court.
- The Superior Court affirmed the trial court's judgment, holding that forceps use does not require specific informed consent.
- The Sinclairs (as appellants) were granted an appeal to the Supreme Court of Pennsylvania, the state's highest court.
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Issue:
Does a physician's use of forceps to facilitate a natural childbirth delivery constitute a surgical or operative procedure that requires the patient's specific informed consent?
Opinions:
Majority - Nix, C.J.
No. The use of forceps to facilitate natural childbirth is not an operative or surgical procedure that implicates the doctrine of informed consent. The court reasoned that informed consent presupposes the patient has a choice to either proceed with a procedure or remain in their current condition. In the case of childbirth, the delivery process is inevitable, and the patient has no choice to make. The use of forceps is merely the application of a tool to assist in the natural delivery process, analogous to using an otoscope, and is therefore covered by the patient's general consent to the delivery. The court separately held that the trial court's general jury instruction on the "two schools of thought" doctrine for the negligence claim was improper because it failed to specify to which of the two distinct negligence allegations—the decision to use forceps versus the manner of their application—the doctrine applied.
Concurring in part and dissenting in part - Papadakos, J.
Yes. The dissent argues that the use of forceps is not part of the natural delivery process but is a 'drastic medical intervention' and an invasive procedure with known, serious risks. A mother should have the right to be informed of these risks and choose an alternative, such as proceeding directly to a Caesarean section. To deny her this choice is illogical and takes away her right to medical self-determination. The opinion concurs with the majority's decision to remand the case for a new trial due to the improper jury instruction on the 'two schools of thought' doctrine.
Analysis:
This decision carves out a significant exception to the informed consent doctrine for medical interventions during inevitable biological processes like childbirth. By focusing on the patient's lack of choice to 'remain in the present condition,' the court narrows the application of informed consent, distinguishing such events from elective or traditional surgical procedures. The ruling suggests that general consent may cover various assistive tools and interventions in similar contexts, potentially impacting litigation over informed consent in emergency medicine or other unstoppable medical events. However, it preserves the separate cause of action for negligence in how such interventions are performed.
