On June 20, 2017, the Pennsylvania Supreme Court issued its decision in
Shinal v. Toms. In a 4-3 decision, the high Court ruled that physicians alone must obtain informed consent from patients before performing medical procedures. As Justice David Wecht writes in the majority opinion, "The duty to obtain the patient's informed consent belongs solely to the physician."
Get the Pennsylvania Medical Society's (PAMED) summary of the
Shinal v. Toms case
PAMED Launched Informed Consent Survey
A Look at Who Responded by Practice Type
Shortly after the decision was announced, PAMED began hearing from our members about the impact the ruling was having on physicians and patients. In August 2017, we released a survey to assess how the
Shinal v. Toms ruling was affecting how physicians serve their patients. The survey was open from Aug. 4 to Aug. 14, 2017.
PAMED received 331 survey responses. The majority (97 percent, 322) were aware of the
Shinal decision. Of those aware of the ruling, the majority reported that they first learned of the decision from PAMED (62 percent, 201 of 322).
How Has the Decision Affected the Informed Consent Process and Patient Care?
The majority of respondents (55 percent, 181 of 331) reported a change in the informed consent process in their work setting. As evidenced by the data below, respondents who experienced changes in their informed consent overwhelmingly voiced their disapproval of those changes.
Overall, I am pleased with the informed consent process in my work setting.||11||19||28||38||85|
The informed consent process has had a positive effect on patient flow in my work setting.||12||18||20||29||102|
Overall, the informed consent process has had a positive effect on the way in which I serve my patients.||11||23||36||28||83|
I preferred the informed consent process I used in my work setting prior to the Supreme Court's decision.||110||40||15||4||12|
Of those 180 respondents who reported a change in their informed consent process, 140 worked in hospital settings and 40 worked in private practice. Of the physicians working in a hospital setting who said their informed consent process changed, 44 percent (62 of 140) reported that their medical staffs were involved in the development of the new informed consent process.
Beyond the Numbers: What Physicians Are Saying
The survey provided physicians with a chance to share their experiences by asking several open-ended questions like "What unplanned outcomes, both positive or negative, have you experienced as a result of the Pa. Supreme Court's decision?" Here's a look at some common responses:
Work Flow/Patient Care Delays: Many respondents explained that, prior to the
Shinal decision, members of their medical staff such as residents, fellows, Physician Assistants (PAs), and Certified Registered Nurse Practitioners (CRNPs) assisted in obtaining informed consent from patients. Following the
Shinal decision, however, physicians have aligned their practice with the Supreme Court's ruling and must personally obtain informed consent. Various negative outcomes were reported by survey respondents as a result of this change. These outcomes included the delay and disruption of both physician work flow and patient care.
Reduced Efficiency: Many respondents commented that the decision has adversely affected their efficiency and productivity.
Uncertainty for Physicians and Patients: Numerous respondents also reported that the decision has created confusion and uncertainty amongst both practitioners and patients.
Impact on Medical Resident Training: Since residents can no longer obtain informed consent, respondents expressed concern that the
Shinal decision negatively impacts resident training and surgical education.
The survey responses suggest that the high Court's decision in
Shinal v. Toms not only drastically impacts how Pennsylvania physicians obtain informed consent, but may also diminish patient quality of care and hinder patient flow. Pennsylvania physicians agree, as demonstrated by PAMED's survey, that the
Shinal decision has negatively impacted how they serve patients and believe that the law should be clarified or changed.
PAMED Will Keep Members Updated on Informed Consent News
On August 16, the PAMED Board of Trustees discussed the recent Supreme Court ruling and agreed to undertake legislative efforts to allow physicians to work with qualified staff to assist in obtaining a patient's informed consent.
PAMED will continue to keep members informed of related developments. Please visit
www.pamedsoc.org/informedconsent for further details on the Court's decision, as well as a member-exclusive video and a
Quick Consult fact sheet.
PAMED's Legal Resource Center
PAMED's Legal Resource Center provides quality, timely legal advocacy and resources for member physicians who practice in Pennsylvania. You'll find:
News on PAMED's strong legal advocacy in the courts, legislature, and state government agencies
Resources about laws and regulations that impact the practice of medicine, in the form of frequently asked questions (FAQs), legal briefs, and more.
Get details at