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43. Medical texts and authorities clearly spell out that Laparotomy is at
best the initial step that is necessary for performing hysterectomy or
salpingo-oopherectomy. Laparotomy by itself is not hysterectomy or
salpingo-oopherectomy. Nor does ’hysterectomy’ include salpingo-
oopherectomy, in the case of woman who has not attained menopause.
Laparotomy does not refer to surgical removal of any vital or
reproductive organs. Laparotomy is usually exploratory and once the
internal organs are exposed and examined and the disease or ailment is
diagnosed, the problem may be addressed and fixed during the course of
such laparotomy (as for example, removal of cysts and fulguration of
endometric area as stated by respondent herself as a conservative form of
treatment). But Laparotomy is never understood as referring to removal
of any organ. In medical circles, it is well recognized that a catch all
clause giving the surgeon permission to do anything necessary does not
give roving authority to remove whatever he fancies may be for the good
of the patient. For example, a surgeon cannot construe a consent to
termination of pregnancy as a consent to sterilize the patient.
44. When the oral and documentary evidence is considered in the light
of the legal position discussed above while answering questions (i) and
(ii), it is clear that there was no consent by the appellant for conducting
hysterectomy and bilateral salpingo-oopherectomy.
45. The Respondent next contended that the consent given by the
appellant’s mother for performing hysterectomy should be considered as
valid consent for performing hysterectomy and salpingo-oopherectomy.
The appellant was neither a minor, nor mentally challenged, nor
incapacitated. When a patient is a competent adult, there is no question of
someone else giving consent on her behalf. There was no medical
emergency during surgery. The appellant was only temporarily
unconscious, undergoing only a diagnostic procedure by way of
laparoscopy. The respondent ought to have waited till the appellant
regained consciousness, discussed the result of the laparoscopic
examination and then taken her consent for the removal of her uterus and
ovaries. In the absence of an emergency and as the matter was still at the
stage of diagnosis, the question of taking her mother’s consent for radical
surgery did not arise. Therefore, such consent by mother cannot be
treated as valid or real consent. Further a consent for hysterectomy, is not
a consent for bilateral salpingo - ooperectomy.
46. There is another facet of the consent given by the appellant’s
mother which requires to be noticed. The respondent’s specific case is that
the appellant had agreed for the surgical removal of uterus and ovaries
depending upon the extent of the lesion. It is also her specific case that
the consent by signing the consent form on 10.5.1995 wherein the
treatment is mentioned as "diagnostic and operative laparoscopy.
Laparotomy may be needed." includes the AH-BSO surgery for removal
of uterus and ovaries. If the term ’laparotomy’ is to include hysterectomy
and salpingo-oopherectomy as contended by the respondent and there
was a specific consent by the appellant in the consent form signed by her
on 10.5.1995, there was absolutely no need for the respondent to send
word through her assistant Dr. Lata Rangan to get the consent of
appellant’s mother for performing hysterectomy under general anesthesia.
The very fact that such consent was sought from appellant’s mother for
conducting hysterectomy is a clear indication that there was no prior
consent for hysterectomy by the appellant.
47. We may, therefore, summarize the factual position thus :
(i) On 9.5.1995 there was no confirmed diagnosis of endometriosis.
The OPD slip does not refer to a provisional diagnosis of
endometriosis on the basis of personal examination. Though there
is a detailed reference to the findings of ultrasound in the entry
relating to 9.5.1995 in the OPD slip, there is no reference to
endometriosis which shows that ultrasound report did not show
43. Medical texts and authorities clearly spell out that Laparotomy is at
best the initial step that is necessary for performing hysterectomy or
salpingo-oopherectomy. Laparotomy by itself is not hysterectomy or
salpingo-oopherectomy. Nor does ’hysterectomy’ include salpingo-
oopherectomy, in the case of woman who has not attained menopause.
Laparotomy does not refer to surgical removal of any vital or
reproductive organs. Laparotomy is usually exploratory and once the
internal organs are exposed and examined and the disease or ailment is
diagnosed, the problem may be addressed and fixed during the course of
such laparotomy (as for example, removal of cysts and fulguration of
endometric area as stated by respondent herself as a conservative form of
treatment). But Laparotomy is never understood as referring to removal
of any organ. In medical circles, it is well recognized that a catch all
clause giving the surgeon permission to do anything necessary does not
give roving authority to remove whatever he fancies may be for the good
of the patient. For example, a surgeon cannot construe a consent to
termination of pregnancy as a consent to sterilize the patient.
44. When the oral and documentary evidence is considered in the light
of the legal position discussed above while answering questions (i) and
(ii), it is clear that there was no consent by the appellant for conducting
hysterectomy and bilateral salpingo-oopherectomy.
45. The Respondent next contended that the consent given by the
appellant’s mother for performing hysterectomy should be considered as
valid consent for performing hysterectomy and salpingo-oopherectomy.
The appellant was neither a minor, nor mentally challenged, nor
incapacitated. When a patient is a competent adult, there is no question of
someone else giving consent on her behalf. There was no medical
emergency during surgery. The appellant was only temporarily
unconscious, undergoing only a diagnostic procedure by way of
laparoscopy. The respondent ought to have waited till the appellant
regained consciousness, discussed the result of the laparoscopic
examination and then taken her consent for the removal of her uterus and
ovaries. In the absence of an emergency and as the matter was still at the
stage of diagnosis, the question of taking her mother’s consent for radical
surgery did not arise. Therefore, such consent by mother cannot be
treated as valid or real consent. Further a consent for hysterectomy, is not
a consent for bilateral salpingo - ooperectomy.
46. There is another facet of the consent given by the appellant’s
mother which requires to be noticed. The respondent’s specific case is that
the appellant had agreed for the surgical removal of uterus and ovaries
depending upon the extent of the lesion. It is also her specific case that
the consent by signing the consent form on 10.5.1995 wherein the
treatment is mentioned as "diagnostic and operative laparoscopy.
Laparotomy may be needed." includes the AH-BSO surgery for removal
of uterus and ovaries. If the term ’laparotomy’ is to include hysterectomy
and salpingo-oopherectomy as contended by the respondent and there
was a specific consent by the appellant in the consent form signed by her
on 10.5.1995, there was absolutely no need for the respondent to send
word through her assistant Dr. Lata Rangan to get the consent of
appellant’s mother for performing hysterectomy under general anesthesia.
The very fact that such consent was sought from appellant’s mother for
conducting hysterectomy is a clear indication that there was no prior
consent for hysterectomy by the appellant.
47. We may, therefore, summarize the factual position thus :
(i) On 9.5.1995 there was no confirmed diagnosis of endometriosis.
The OPD slip does not refer to a provisional diagnosis of
endometriosis on the basis of personal examination. Though there
is a detailed reference to the findings of ultrasound in the entry
relating to 9.5.1995 in the OPD slip, there is no reference to
endometriosis which shows that ultrasound report did not show
