Court ruling in his case established doctrine of informed medical consent
Jerry Canterbury was just out of high school when he boarded a Greyhound bus to Washington to join the FBI as a clerk, a job that was to be his ticket out of the coal mines of West Virginia. He had barely settled into his new life when he developed a sharp pain in his back.
In 1959, at 19, he agreed to undergo a spinal surgery known as a laminectomy — a procedure expected to resolve a ruptured disc and that he said his doctor described as “no more serious than an ordinary, everyday operation.”
The day after the surgery, Mr. Canterbury fell at the hospital while attempting to empty his bladder. Another operation followed. By the time he was discharged more than three months later, he was partially paralyzed in the legs and permanently incontinent. He would spend the rest of his life on crutches, then in a wheelchair and finally confined to a bed.
Mr. Canterbury, who has died at 78, sued his surgeon, William T. Spence, accusing him of having failed to adequately warn him of the risks of his surgery. The physician ultimately prevailed, but a 1972 federal appeals court decision in the case became a foundation of the doctrine of informed consent and, by extension, the modern practice of medicine.
Robert Veatch, a professor emeritus at the Kennedy Institute of Ethics at Georgetown University, said that he has taught Canterbury v. Spence to more than 15,000 students and considers it “one of the most important cases in medical ethics.”
Arthur Caplan, head of the bioethics division at New York University’s medical school, said the decision has “reverberated into health law and bioethics and our thinking of doctor-patient relationships even to the present day, even though he lost.”
Mr. Canterbury’s death — on March 15 at his home in Hartville, Ohio — was announced weeks ago in a notice in the Canton, Ohio, Repository, but it did not receive wide attention until it was reported by the New York Times on May 16. Mr. Canterbury’s sister, Nancy Farahmand, said her brother died of chronic obstructive pulmonary disease.
The concept of patient consent — the right to submit or not submit to a treatment — had existed in medicine at least since the early 20th century. By the 1950s, consent had begun to evolve into informed consent, or the notion that a physician must advise a patient of the risks and benefits of, as well as the alternatives to, a proposed treatment before proceeding.
Around that time, doctors gradually discarded the commonplace practice of withholding upsetting news, such as cancer diagnoses, to allow patients to participate more fully in their care. But when seeking informed consent, they generally revealed only information that another doctor might provide — a rule known as the professional standard.
It was in that context that Mr. Canterbury’s case worked its way through the legal system. At trial, in 1968, his doctor argued that Mr. Canterbury’s paralysis had resulted not from the surgery, but rather from his original spinal condition.
Spence did concede, however, that paralysis could occur “somewhere in the nature of one percent” of laminectomies, according to an account of the case by Alan Meisel, the founder of the University of Pittsburgh’s Center for Bioethics and Health Law. Spence would later testify that he had warned Mr. Canterbury only of “weakness,” not potential paralysis.
The court granted a motion for a directed verdict in Spence’s favor. Mr. Canterbury appealed, leading to the landmark decision by Judge Spottswood W. Robinson III of the U.S. Court of Appeals for the District of Columbia.
Robinson rejected the paternalism of the professional standard, writing that “respect for the patient’s right of self-determination on particular therapy demands a standard set by law for physicians rather than one which physicians may or may not impose upon themselves.”
The decision empowered patients by establishing a new standard: Rather than revealing the risks and benefits another reasonable doctor would disclose, physicians must disclose the information a reasonable patient would wish to know. In essence, the decision affirmed patient autonomy and acknowledged that, in certain personal decisions, a doctor might not always know best.
The decision, which is widely although not universally followed, also had the effect of lengthening doctor’s office consent forms and inviting litigation, Caplan noted dryly. Some doctors have lamented that the new standard imposed upon them the burden of disclosing every possible misfortune, however improbable, that might result from a medical procedure. But the decision is generally understood to have contributed to a more robust definition of patients’ rights and richer doctor-patient relationships.
The appeals court remanded Mr. Canterbury’s case for new trial. Again he lost. Between the two trials, he elected to undergo a second laminectomy for newly developed back pain, a fact that seemed to discredit his claim that he would have refused the first procedure had he known its risks. In his account of the case, however, Meisel noted that the second procedure presented fewer risks, given that Mr. Canterbury was already paralyzed.
Jerry Watson Canterbury was born in Cyclone, W.Va., on March 12, 1939. His father died after a mining accident when Mr. Canterbury was 9. His mother wanted to “make certain that her children did not follow their father into the coal mines,” Mr. Canterbury’s sister said.
After his surgeries, the FBI transferred Mr. Canterbury to positions in warmer climates. He left the FBI in 1962 and moved eventually to Ohio, where he worked for a steel company, the Ohio State Highway Patrol and as a sheriff ’s office dispatcher before retiring on disability.
His marriage to Lillian Hyde ended in divorce. Survivors include three brothers, as well as his sister. She said that her brother suffered from depression as he first confronted his disability but that, as he aged, he “accepted his new reality” with grace.
Not until about a decade ago, when Meisel interviewed him, did Mr. Canterbury learn of the far-reaching effects of his case.
“We certainly all benefited from the changes in the law resulting from the fact that this case took place,” Jerry Menikoff, head of the office for human research protections at the U.S. Health and Human Services Department, said in an interview. “The law began a process of improvement in following more ethical standards, but unfortunately for Jerry Canterbury himself, it didn’t help him.”
Jerry Canterbury’s suit over his paralysis failed but the case altered modern medicine.