CHEONGJU – In a significant ruling regarding the boundaries of patient autonomy and medical expertise, a South Korean court has clarified that while patients have the right to consent to a procedure, the order in which multiple treatments are performed remains the exclusive domain of medical professionals.

On January 16, the Cheongju District Court, presided over by Judge Kim Hyeon-ryong, dismissed a medical malpractice and damages lawsuit filed by the bereaved family of a patient, identified as "A," against a National University Hospital. The plaintiffs sought compensation following A’s death, alleging that the hospital's decision to prioritize diabetic foot surgery over a heart procedure led to a fatal delay.

The Clinical Timeline

The case dates back to March 2023, when A was hospitalized for a severe diabetic foot infection. Diagnostic tests revealed two critical issues: arterial blockage in the leg and 60–95% stenosis in three coronary arteries. The medical team decided on a staged approach: perform the urgent diabetic foot surgery first to prevent necrosis, followed by coronary stent insertion after discharge.

However, in May 2023, while recovering from foot surgery, A complained of chest pain. Although nursing staff checked vital signs and alerted the doctor on duty, A suffered a cardiac arrest shortly after. Despite resuscitation and emergency heart surgery, A died from hypoxic brain damage.

Legal Reasoning and the "Duty to Explain"

The bereaved family argued that the medical team failed to sufficiently explain the risks of delaying the heart procedure, thereby violating the patient’s right to self-determination. They also alleged negligence in monitoring the patient after he reported chest pains.

The court rejected these claims. Regarding the monitoring, the judge noted that medical records showed the nursing staff responded immediately and that the patient’s vital signs were stable at the time of the initial report.

More importantly, the court addressed the limits of the "duty to explain." The ruling stated that a physician’s obligation to provide information is intended to allow a patient to choose whether to undergo a specific invasive treatment. However, deciding which of two necessary invasive procedures to perform first is not a decision that belongs to the patient.

"The issue of deciding the order of necessary medical treatments is a matter to be determined based on the medical judgment of the healthcare team," the court stated. "It is not a matter to be left to the patient’s self-determination."

Conclusion

By ruling that the sequence of treatment is a clinical decision rather than a choice of consent, the court reaffirmed the professional discretion of doctors in managing complex, multi-stage treatments. The ruling emphasizes that since the cardiac arrest was caused by the underlying disease (acute myocardial infarction) and not the surgery itself, the hospital could not be held liable for a violation of the duty to explain.

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