Martin Salgo and the Dawn of Patient Autonomy

On January 8, 1954, Martin Salgo underwent a translumbar aortogram for a presumptive diagnosis of mid-aortic occlusion. Postprocedure paraplegia occurred, and Mr. Salgo filed a medical malpractice lawsuit claiming, among other causes of action, negligence, breach of a duty to warn, and unauthorized human experimentation. The trial jury initially awarded the plaintiff $250,000. On appeal, Judge Absalom F. Bray reversed the verdict, noting errors of law, specifically, an incorrect theory of negligence. The judge's opinion highlighted two other important elements of patient autonomy and most famously gave rise to the medicolegal term of art informed consent. But the opinion set out a more nuanced version of a physician and surgeon's duty to warn than is generally understood. Also highlighted, coming only 5 years after the Nuremberg Doctors' trials were published in 1949, was clarification of the difference between clinical care and human experimentation. The case of Salgo v. Leland Stanford Jr. University et al and its aftermath deserve to be reconsidered as arguably the most important case in medicolegal history and a milestone in advancing the ethical principle of patient autonomy.