Surgeons, Hernia Surgery and Informed Consent in the Seventeenth Century Ottoman Istanbul.

backgroundIn the seventeenth century Ottoman Istanbul, especially Greek surgeons specialized in hernia surgery. Both Muslim and non-Muslim patients had signed contracts with surgeons in sharia courts before undergoing a surgery. In this study, we analyze these documents, which serve as informed consent in the Ottoman period, in detail.

methodsWe used Istanbul Sharia Court Registers (Istanbul Sicils) as the primary information source. We scanned a total of twenty nine registers dating back to the seventeenth century. In six of these registers, we determined a total of twenty one informed consents (known as rıza senedi in Turkish literature) regarding hernia surgery and surgeons. Based on these data, we examined the surgeons and hernia surgeries, the fees received by surgeons, and the informed consent documents of the seventeenth-century Istanbul.

resultsIn the scanned informed consents, we identified five male surgeons and twenty one patients. While four of the surgeons were Greek, one of them was Muslim. The contracts show that the patients were informed about possible complications before operations, and their permissions were obtained accordingly. The contracts also clearly state that a blood-money from the surgeons would not be requested if a patient dies during or after an operation. The cost of operations ranged between 500 and 2100 aḳče.

conclusionsThe patient-physician relationship in Ottomans was seen as a business relationship. Medical processes were recorded in courts before treatment fees were paid. These court records had been a practice that protected the patients and the physicians in terms of criminal liability.