Malette v. Shulman Case and its Impact on Patient Autonomy

This case study analyzes the Malette v. Shulman case, a landmark legal decision concerning informed consent and patient autonomy. The case involved a doctor who performed a blood transfusion on an unconscious patient despite knowing the patient's opposition based on religious beliefs. The court ruled in favor of the patient, emphasizing the importance of respecting a patient's wishes and values, even when unconscious. The ruling significantly impacted laws and ethical principles, particularly in Canada, establishing informed consent as a crucial requirement in medical practice. The case highlights the legal and ethical dimensions of patient rights, influencing the development of principles such as beneficence, non-maleficence, and justice. The study explores how the ruling ensures patient autonomy, which is the right of every individual to make decisions about their health and well-being. The analysis also examines potential conflicts between laws and religious beliefs, and the measures taken to ensure informed consent is observed, for instance, requiring patients to sign consent forms before medical procedures.

Running head: MALETTE V. SHULMAN CASE AND ITS IMPLICATIONS
Malette v. Shulman Case and its Implications
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Malette v. Shulman Case and its Implications
Introduction
The topic of informed consent/patient autonomy has become very popular in the
contemporary society. The topic has both legal and ethical orientations. Informed consent
simply refers to the practice of informing the patients of the implications of a medical
procedure/intervention and leaving them to decide on whether to have the treatment or not
(American Medical Association, 2016). The health care professional is bound by law and
code of ethics to respect the decision of the patient (Holland, Fistein and Walsh, 2018). The
principle of informed consent has been attributed to the Malette v. Shulman case of 1980.
The case involved a situation where a doctor carries out a blood transfusion despite having
the knowledge that the patient is opposed to it. Although the patient was unconscious the
doctor accessed a card in which she stated that under no circumstance should a blood
transfusion be done. The decision of the patient was informed by her strong religious beliefs.
The patient later sues the doctor for failing to honour her statement. The judge rule in favour
of the plaintiff emphasizing the importance of respecting the decision that an individual has
made concerning their health.
Impact of the Case to Laws in the Contemporary Society
The case has greatly impacted the laws of the current society and those of Canada.
This is particularly in the informed consent requirement. In the modern world, the issue of
informed consent and patient assisted dying have become contemporary issues (Young,
2017). It is not only a matter of the but ethics. This section will look at the changes/impacts
made because of the case. Informed consent simply refers to a situation where a health care
provider can only carry out certain procedures or treatment to patients only if the
patient/client consents to it. If the patient does not consent, then the health care provider is

MALETTE V. SHULMAN CASE AND ITS IMPLICATIONS 3
bound by both law and ethics not to carry out the procedure. This regulation stemmed from
the case explained above and have become an important legal requirement in the practice of
medicine in many countries including Canada. Before deciding about their health, the law
requires that the patient be informed on the implications of consenting or failure to consent to
their health (Herring, 2015). This means that the patient makes an informed decision. In the
contemporary society, the legal significance of informed consent is to ensure that the
patient/client is protected from the from assault and battery in the form of medical
interventions that they do not want (Foster and Herring, 2018). The patient may understand
that the health implications of a medical intervention are vital for their survival but still
decline the intervention. In such cases, the medical team has no option but to respect the
decision of the patient. Going against their wish is a breach of informed consent requirement
and could be charged in a court of law.
As observed above, the determination of the case has greatly contributed to the
formation of the current regulations concerning informed consent. Although this is the case,
various jurisdictions have unique laws concerning the same. It is therefore necessary for
health care professionals to be aware of the legal requirement in their jurisdictions and adapt
appropriately. For instance, the Medical Protective Association of Canada provides details
guidelines on how the health care professionals should act. The concept of informed consent
has some ethical orientation. Ethics apply in terms of showing respect of the decision made
by the patient. In other words, it is ethical to respect the decision that the patient make
regarding their own health regardless of the implications of their decision. This seems to be a
perfect enactment of the decision that the judge made on the Malette v. Shulman case. The
judge concluded that the intentions of the doctor were good and were aimed at ensuring that
the patient is protected from harm. He also added that the doctor followed the ethics of

MALETTE V. SHULMAN CASE AND ITS IMPLICATIONS 4
medicine. The only issue that he did wrong was to ignore the wish of the patient despite being
aware of it.
In addition to the concept of informed consent, the case seems to have influenced the
formation of the four main principles of ethics. The first principle is that of informed consent.
The other principle is of beneficence. This stipulates that a health care professional should
ensure that all their actions are geared towards ensuring the most benefit to their patient/
clients (Downie, 2016). The third principle is that of non-maleficence. This principle
stipulates that a health care professional should not do anything that will cause harm to the
patient. It also requires the professional to do all they can to prevent or minimise any form of
harm that may befall their patient. The final principle is that of justice. It burdens the health
care profession to ensure that the benefits of medical care are equally distributed to all
members of the society. These principles are integrated in to the professional code of ethics
of most health care professionals around the world. This includes Canada. Extensive evidence
has revealed that the above-mentioned case significantly contributed to development of these
principles. Any professional who does not observe the principles risks having appropriate
punitive measures taken against them.
The issue of informed consent has become so important that most governments have
intervened to ensure that it is observed (Percival, 2014). This is through putting some
measures and mechanisms that ensures the process of informed consent is being carried out.
For instance, a patient is required to fill a consent form before entering the operating theatre
for an operation. The signed document serves as evidence that the patient consented or did
not (Rai and Porter, 2014). As observed in the discussion above, the patient must be educated
on the implication of procedure before consenting. By failing to consent therefore, the patient
agrees that they are knowledgeable about the consequences but still do not want the medical
intervention (Diesfeld, 2018).

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The Importance of the Regulation Used in the Case
One might argue that the judges were unfair for punishing the doctor. After all, the
doctor was doing his work and trying his best to save a life. In fact, the judge acknowledges
that the life of the plaintiff could not be were it not for the intervention. However, the
regulation set by the case presents a very important issue. This is the issue of patient
autonomy. Every human being on earth has a right to make decisions concerning their health
(Carter and Rodgerson, 2017). People are different in many ways. People may value religion,
culture, education or some other aspect. What one-person values may be completely different
from what another values. For this reason, it is important for each person to respect others
and their values (Hope and Dunn, 2018).
The regulation used in this case illustrate very well the importance of respecting the
decisions that a person has made. The plaintiff had clearly indicated her wish concerning
blood transfusion. She has said that she wouldn’t want a blood transfusion to be done under
any circumstance. Although the doctor’s move aimed at protecting her life and alleviating
harm, he failed to respect her values. She valued her religion to the extent that she was ready
to die rather than have a blood transfusion. This is evidenced by her move to sue the doctor.
The move illustrates that her religious values are very important to her and the doctor
disregarded them. In a nutshell, the regulations have helped the medical profession, both in
Canada and other places to understand the importance of ensuring patient autonomy.
How the Law Conflicts with Religious Views
In most jurisdictions the freedom of religion is provided for. However, the
government has rules and regulations that must be followed by all citizens despite their

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religious beliefs/views (Sullivan, 2018). For instance, some jurisdictions allow for marriage
between same sex marriages. Most religions are usually against this, but they have no option
but to respect the law. Another law that is applied in most jurisdictions is allowing the use of
alcohol and some other drugs such as tobacco. Most religions prohibit the use of the drugs.
Despite the prohibition, the law must be followed. Another instance where the law conflicts
with religion, is the promotion of family planning practices. Most governments are aiming at
controlling the populations using family planning. Some religions such as Christianity are
opposed to such a move. These examples represent just but a few of the conflicts between
laws and religion.
Conclusion.
The Malette v. Shulman case brought a revolution in the practice of medicine. The
case involved a doctor who carried out a blood transfusion on a patient despite knowing that
the patient was objected to it. Although the patient was unconscious, she had indicated the
information on a card which the doctor saw. The judge charged the doctor of battery since he
knowingly carried out a medical intervention that the patient was opposed to. The case has
greatly contributed to the development of the legal and ethical requirement of informed
consent/patient autonomy in the contemporary society.

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