Patient consent and negotiation in the Brooklyn gynecological practice of Alexander J.C. Skene: 1863-1900

The prevailing view in bioethics is that the relationship between doctors and their patients was largely a silent one before the landmark court decisions of the twentieth century. Some have proposed that this was not always the case. This paper provides historical evidence of consent and negotiation in one nineteenth century gynecological practice. The Clinical Records and writings of Dr. Alexander J.C. Skene, who practiced in Brooklyn, New York from 1863 to 1900, have been examined for evidence of discussion, consent and even negotiation with patients. Although this evidence comes from only one practice, it is especially significant because it was largely a gynecological practice with women who were varied in socioeconomic status and ethnic origin. The importance of documenting physician-patient relationships which included patients in decision-making before Schloendorff (1914) established the legal doctrine of informed consent cannot be underestimated.