Informed consent principle

The Informed consent principle protects patient autonomy by requiring clinicians to disclose the nature, risks, benefits, and alternatives of proposed medical interventions. In the account of the crisis at Memorial Medical Center, the principle helps define the limits of a Do Not Resuscitate order: a decision not to revive someone whose breathing or heartbeat has stopped is not, on its own, a decision to decline other treatment or rescue.

Definition and Purpose

Informed consent is described as a legal concept established in the United States beginning in the 1950s. It arose in response to historical abuses and requires doctors to explain what an intervention involves, its risks and benefits, and what alternatives are available. Consent is generally given by the patient or, when appropriate, a health-care proxy. The principle makes disclosure part of medical decision-making rather than treating a clinician’s judgment as a substitute for the patient’s choice.

The Meaning of a DNR Order

The distinction between a Do Not Resuscitate order and a living will is central to the principle’s application. A DNR order addresses a specific circumstance: if a patient’s heartbeat or breathing stops, the patient should not be revived. A living will, by contrast, could allow a patient under Louisiana law to request in advance that life-sustaining procedures be withheld or withdrawn in the event of a terminal and irreversible condition. The two documents therefore express different choices and cannot be treated as interchangeable evidence of a patient’s wishes.

The Evacuation Decision at Memorial

During the hospital’s evacuation, Memorial doctors made an exception to the usual priority of sending the sickest and most technologically dependent patients first: patients with DNR orders would go last. Four DNR patients were in the ICU, including Jannie Burgess. The decision gave an order about resuscitation a much wider practical effect, determining a patient’s place in the evacuation sequence.

Richard Deichmann later explained that he believed the law required DNR patients to have a certified terminal or irreversible condition. He also believed such patients had less to lose if disaster struck. Bill Armington recalled reasoning that patients who did not want their lives prolonged by extraordinary measures would not want to be saved at others’ expense. But neither the orders nor Memorial’s disaster plans stated that DNR patients should be left until last. The principle’s relevance lies in this gap: an assumption about what a patient would choose is not the same as informed consent to that choice.

Scope and Significance

The principle does not itself determine how to allocate evacuation resources in a disaster. It does, however, clarify what a documented medical preference does—and does not—authorize others to infer. At Memorial, the limited meaning of DNR mattered because the hospital’s evacuation rule converted that status into a broader priority judgment without a corresponding statement in the patients’ orders or the disaster plans. The distinction preserves the force of patient autonomy: declining resuscitation in one defined circumstance does not automatically amount to declining continued care or a chance to be evacuated.