Hostname: page-component-848d4c4894-ndmmz Total loading time: 0 Render date: 2024-05-10T23:00:52.165Z Has data issue: false hasContentIssue false

Phantom Tumors and Hysterical Women: Revising our View of the Schloendorff Case

Published online by Cambridge University Press:  01 January 2021

Extract

Over the past thirty years, the doctrine of informed consent has become a focal point in discussions of medical ethics. The literature of informed consent explores the evolution of the principle of autonomy, purportedly emerging from the mists of 19th Century medical practice, and finding its earliest articulation in legal cases where wronged citizens asserted their rights against medical authority. A commonplace, if not obligatory, feature of that literature is a reference to the case of Mary Schloendorff and the opinion written by Judge Benjamin Cardozo by which the case is remembered. Commentators today applaud the prescience of Cardozo for an early articulation of what eventually would become bioethical orthodoxy concerning informed consent and its place as a bulwark of patient autonomy. They inevitably quote Cardozo's famous statement, “Every human being of adult years and sound mind has a right to determine what shall be done with his own body.”

Type
Article
Copyright
Copyright © American Society of Law, Medicine and Ethics 2005

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Schloendorff v. New York Hospital, 211 N.Y. 125, 129–130 (1914).Google Scholar
“Informed Consent” in Encyclopedia of Bioethics, revised edition, vol. 3, Reich, W. T., ed. (New York: Simon & Schuster Macmillan, 1995): 1234.Google Scholar
See, for example, Faden, R. R. and Beauchamp, T. L., A History and Theory of Informed Consent (New York: Oxford University Press, 1986), calling Schloendorff “a powerful rallying symbol in the informed consent literature” (28) and “a classic statement of the patient's right to self-determination” (123).Google Scholar
Phillips v. Buffalo General Hospital, 239 N.Y. 188 (1924).Google Scholar
Bing v. Thunig, 2 N.Y.2d 656, at 667 (1957).Google Scholar
Posner, R., Cardoso: A Study in Reputation (Chicago: University of Chicago Press, 1990): At 3.Google Scholar
Schloendorff v. New York Hospital, supra note 1, at 127.Google Scholar
Schloendorff v. New York Hospital, supra note 1, at 127–128.Google Scholar
Schloendorff v. New York Hospital, supra note 1, at 129–130.Google Scholar
Schloendorff v. New York Hospital, supra note 1, at 131–132.Google Scholar
Schloendorff v. New York Hospital, supra note 1, at 135.Google Scholar
MacDonald v. Massachusetts General Hospital, 120 Mass. 432 (1876). An extensive discussion of the history of charitable immunity for hospitals is contained in Bobbe, S. S., “Tort Liability of Hospitals in New York,” Cornell Law Quarterly 37 (1951–1952): 419438.Google Scholar
Holliday v. St. Leonard's, 11 C.B.H.S. 192, 142 Eng. Rep. 769 (1861).Google Scholar
Mersey Docks Trustees v. Gibbs, L.R. 11 H.L. Cas. 686 (1866).Google Scholar
See Bobbe, , supra note 13, for cases rejecting the “implied waiver” rule.Google Scholar
Vogel, M. J., The Invention of the Modern Hospital: Boston, 1870–1930 (Chicago and London: University of Chicago Press, 1980): 106107. One commentator noted that long before Schloendorff states such as Rhode Island had concluded that even charitable hospitals could be held liable for the misadventures of surgeons, even though they received no pay from the hospital. Kinkead, E. B., Commentaries on the Law of Torts, vol 1 (San Francisco: Bancroft-Whitney, 1903): At 209–212. The Rhode Island case (Glavin v. Rhode Island Hospital, 12 R.I. 411 [1879]) was cited by Cardozo for a different proposition, to demonstrate that a master/servant relationship does not usually exist between outside doctors and hospitals.Google Scholar
Court of Appeals, State of New York, Briefs and Records, Mary E. Schloendorff against The Society of the New York Hospital, (1914), Testimony of Henry Crane, at 176–177 (hereafter, Transcript).Google Scholar
Bobbe, , supra note 13, at 427.Google Scholar
Schloendorff v. New York Hospital, supra note 1, at 134.Google Scholar
Kaufman, A., Cardozo (Cambridge, MA: Harvard University Press, 1998): At 252.Google Scholar
New York World, May 4, 1911, at 5.Google Scholar
Transcript, supra note 18, at 2.Google Scholar
Schloendorff v. Society of New York Hospital, 133 N.Y.S. 1143 (1912). Though the decision of the Appellate Division of the Supreme Court was rendered without an opinion, one judge noted his dissent.Google Scholar
Transcript, supra note 18, at 16–17.Google Scholar
Recurring references to Schloendorff's “nervousness” suggest a barely submerged theory of hysteria linking parts of the medical testimony. It was not uncommon for doctors to claim that surgical interventions such as hysterectomy would cure a woman's insanity. See, for example, “Insanity and Pelvic Lesions,” Medical News 76, February 3, 1900, at 176. For a summary of the literature on hysteria, see Micale, M., Approaching Hysteria: Disease and Its Interpretations (Princeton, NJ: Princeton University Press, 1995).Google Scholar
Transcript, supra note 18, at 17–19.CrossRefGoogle Scholar
Transcript, supra note 18, at 20.Google Scholar
Transcript, supra note 18, at 21.Google Scholar
Transcript, supra note 18, at 22.Google Scholar
Transcript, supra note 18, at 192; Transcript, supra note 18, “Plaintiff's Exhibit # 4,” January 30, 1907 (Letter to Emily Lux), at 205.Google Scholar
Transcript, supra note 18, at 24.Google Scholar
Transcript, supra note 18, at 35.CrossRefGoogle Scholar
Transcript, supra note 18, at 124.Google Scholar
Transcript, supra note 18, at 54.Google Scholar
Transcript, supra note 18, at 162.Google Scholar
Transcript, supra note 18, at 163.Google Scholar
Transcript, supra note 18, at 25–26.CrossRefGoogle Scholar
Transcript, supra note 18, at 196.Google Scholar
Transcript, supra note 18, at 51 (Testimony of Evan Gamble).Google Scholar
Transcript, supra note 18, at 31.Google Scholar
Transcript, supra note 18, at 56–61.Google Scholar
Transcript, supra note 18, at 62.CrossRefGoogle Scholar
Transcript, supra note 18, at 67.Google Scholar
Transcript, supra note 18, at 149 (Testimony of Dr. Otto Goehle).Google Scholar
Transcript, supra note 18, at 189 (Testimony of Dr. George M. Cottle).Google Scholar
Morantz-Sanchez, R., Conduct Unbecoming a Woman: Medicine on Trial in Turn-of-the-Century Brooklyn (New York: Oxford University Press, 1999): 77.Google Scholar
“Uterine Fibroids,” Health 62 (August 1912): 179.Google Scholar
Goffe, J. R., “What Advice Should be Given to a Woman Suffering from Fibroid Tumor of the Uterus?” Medical News 82 (February 7, 1903): 247249.Google Scholar
Goelet, A. H., “The Palliative Treatment of Fibroid Tumors of the Uterus,” Medical News 83 (August 8, 1903): 258260.Google Scholar
Webster, C. J., “A Consideration of Fibroid Tumors of the Uterus Based Upon a Series of Cases Treated Surgically,” Medical News 86 (April 22, 1905): 764768.Google Scholar
Deaver, J. B., “A Year's Work in Hysterectomy,” The American Journal of the Medical Sciences 145 (April 1913): 469474.CrossRefGoogle Scholar
Transcript, supra note 18, at 57.Google Scholar
Transcript, supra note 18, at 38.Google Scholar
Transcript, supra note 18, at 40–44.Google Scholar
Transcript, supra note 18, at 45 (Testimony of Lillias M. Reeve).Google Scholar
Transcript, supra note 18, at 191, 192 (Testimony of George M. Cottle and Testimony of Lillias M. Reeve, in rebuttal).Google Scholar
Transcript, supra note 18, at 125.Google Scholar
Transcript, supra note 18, at 110.Google Scholar
Transcript, supra note 18, at 117.Google Scholar
Transcript, supra note 18, at 108.Google Scholar
Transcript, supra note 18, at 49.Google Scholar
Transcript, supra note 18, at 129.Google Scholar
Lest this issue seem too clear, yet another physician testified: “It is not the custom to operate without the consent of friends of the patient, such friends being matters of record in the office of the institution where they happen to be placed.” Transcript, supra note 18, at 167 (Testimony of Dr. William M.Polk).Google Scholar
Pernick, M., “The Patient's Role in Medical Decisionmaking: A Social History of Informed Consent,” in President's Commission for the Study of Ethical Problems in Medicine and Biomedical Research, Making Health Care Decisions: The Ethical and Legal Implications of Informed Consent in the Patient-Practitioner Relationship (Washington, DC: Government Printing Office, 1982) Appendices: Studies on the Foundations of Informed Consent, volume 3: At 4, 11.Google Scholar
Kinkead, E. B., Commentaries on the Law of Torts, vol. 1 (San Francisco: Bancroft-Whitney, 1903): 375.Google Scholar
Mohr v. Williams (95 Minn. 261, 268 [1905]).Google Scholar
Mohr v. Williams, supra note 69, at 269.Google Scholar
Mohr v. Williams, supra note 69, at 271.Google Scholar
Pratt v. Davis (224 Ill. 300, 305 [1906]).Google Scholar
Rishworth v. Moss (159 S. W. 122, 124 [Tex. 1913]).Google Scholar
Rishworth v. Moss, supra note 73, at 124.Google Scholar
Rolater v. Strain (137 Pac. 96, 98 [Okl. 1913]).Google Scholar
This is the conclusion of some of the most thorough commentary on the case as well; see Katz, J., The Silent World of Doctor and Patient (New York: Free Press, 1984): 5152. Katz is the only commentator I have identified in the bioethics literature who realized that the operation on Mary Schloendorff was a hysterectomy. His attention to the gynecological focus of the Schloendorff surgery is echoed by Kathleen E. Powderly, who also challenges Katz's view that consent was not commonly sought, while crediting the Schloendorff case with establishing the legal doctrine of informed consent. See Powderly, K. E., “Patient Consent and Negotiation in the Brooklyn Gynecological Practice of Alexander J. C. Skene: 1863–1900,” Journal of Medicine and Philosophy 25 (2000): 1227. One recent Cardozo biographer also identifies the hysterectomy amid an extensive analysis of the case, describing it along with similar personal injury cases that generated Cardozo opinions as an example of judicial deference to the learned professions, see Polenberg, R., The World of Benjamin Cardozo (Cambridge, MA: Harvard University Press, 1997): 108114.Google Scholar
“From the earliest of times under the English, and later the American, common law, consent of the patient to medical treatment has been required in all but exceptional circumstances,” Lidz, C. W., Meisel, A., “Informed Consent and the Structure of Medical Care,” in President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research, Making Health Care Decisions: The Ethical and Legal Implications of Informed Consent in the Patient-Practitioner Relationship (Washington, DC: U.S. Government Printing Office, 1982), Appendices: Empirical Studies of Informed Consent, volume 2: At 317; for criminal prohibitions on surgery without consent, see The Colonial Laws of Massachusetts Reported from the Edition of 1660, “Chirurgions, Midwives, Physicians,” 1649, L.2.P.3.Google Scholar