Title: Marlene Brown v. David G. Dibbell, M.D.
Citation: N/A
Docket Number: 1997AP002181
State: Wisconsin
Issuer: Wisconsin Supreme Court
Date: June 23, 1999

SUPREME COURT OF WISCONSIN 
 
 
Case No.: 
97-2181 
 
 
Complete Title 
of Case: 
 
 
Marlene Brown and Kurt Brown,  
 
Plaintiffs-Appellants-Cross-Respondents-
 
Cross Petitioners, 
v. 
David G. Dibbell, M.D., Midelfort Clinic, Ltd., 
a Mayo Regional Practice, and Physicians 
Insurance Company of Wisconsin,  
 
Defendants-Respondents-Cross-Appellants-
 
Petitioners, 
Steven D. Johnson, M.D., Meridian Resource 
Corporation on behalf of Benefit Plan 
Administrators Co. and Wisconsin Physicians 
Service-Medicare Part B,  
 
Defendants.  
 
ON REVIEW OF A DECISION OF THE COURT OF APPEALS 
Reported at:  220 Wis. 2d 200, 582 N.W.2d 134 
 
 
 
(Ct. App. 1998-Published) 
 
 
Opinion Filed: 
June 23, 1999 
Submitted on Briefs: 
 
Oral Argument: 
April 8, 1999 
 
 
Source of APPEAL 
 
COURT: 
Circuit 
 
COUNTY: 
Trempealeau 
 
JUDGE: 
John A. Damon 
 
 
JUSTICES: 
 
Concurred: 
 
 
Dissented: 
 
 
Not Participating:  
 
 
ATTORNEYS: 
For the defendants-respondents-cross-appellants-
petitioner’s there were briefs by Joy L. O’Grosky, Curtis C. 
Swanson, Rita M. Knauss, Nicholas S. Harned and Axley Brynelson, 
LLP, Madison and oral argument by Joy L. O’Grosky. 
 
 
 
For the plaintiffs-appellants-cross respondents-
cross petitioners there were briefs by Thomas Kent Guelzow, 
Michael L. Laufenberg and Guelzow & Laufenberg, Ltd., Eau Claire 
and oral argument by Thomas Kent Guelzow. 
 
 
Amicus curiae brief was filed by D.J. Weis and 
Habush, Habush, Davis & Rottier, S.C., Rhinelander for the 
Wisconsin Academy of Trial Lawyers. 
 
 
Amicus curiae brief was filed by William H. 
Levit, Jr., Michael B. Apfeld and Godfrey & Kahn, S.C., Milwaukee 
and Steven J. Caulum and Bell, Gierhart & Moore, S.C., Madison 
for the Wisconsin Patients Compensation Fund. 
 
No. 97-2181 
 
1 
 
NOTICE 
This opinion is subject to further editing and 
modification.  The final version will appear in 
the bound volume of the official reports. 
 
 
No. 97-2181 
 
STATE OF WISCONSIN               :        
        
 
 
 
 
IN SUPREME COURT 
 
 
Marlene Brown and Kurt Brown,  
 
          Plaintiffs-Appellants-Cross- 
          Respondents-Cross Petitioners, 
 
     v. 
 
David G. Dibbell, M.D., Midelfort Clinic,  
Ltd., a Mayo Regional Practice, and  
Physicians Insurance Company of  
Wisconsin,  
 
          Defendants-Respondents-Cross- 
          Appellants-Petitioners, 
 
Steven D. Johnson, M.D., Meridian  
Resource Corporation on behalf of Benefit  
Plan Administrators Co. and Wisconsin  
Physicians Service-Medicare Part B,  
 
          Defendants.  
 
FILED 
 
JUN 23, 1999 
 
Marilyn L. Graves 
Clerk of Supreme Court 
Madison, WI 
 
 
 
 
 
REVIEW of a decision of the Court of Appeals.  Affirmed.  
¶1 
SHIRLEY S. ABRAHAMSON, CHIEF JUSTICE.   This is a 
review of a published opinion of the court of appeals, Brown v. 
Dibbell, 220 Wis. 2d 200, 582 N.W.2d 134 (Ct. App. 1998).  The 
Circuit Court for Trempealeau County, John A. Damon, Judge, 
entered judgment in favor of Marlene Brown and her husband Kurt 
Brown 
against 
David 
G. 
Dibbell, 
Midelfort 
Clinic, 
Ltd., 
Physicians Insurance Company of Wisconsin and Wisconsin Patients 
No. 97-2181 
 
2 
Compensation Fund.1  The court of appeals concluded that the 
circuit court had erred and remanded the cause for a new trial. 
¶2 
Marlene Brown and her husband, Kurt Brown, referred to 
collectively as the plaintiffs, allege that Ms. Brown sustained 
injuries as a result of Dr. David G. Dibbell's violation of the 
Wisconsin informed consent statute, Wis. Stat. § 448.30 (1993-
94).2  The plaintiffs sued Dr. Dibbell; the Midelfort Clinic, 
Ltd., 
which 
employed 
Dr. 
Dibbell; 
their 
joint 
insurer, 
Physicians Insurance Company of Wisconsin; and the Wisconsin 
Patients Compensation Fund, referred to collectively as the 
defendants.3 
¶3 
Two issues are presented in this informed consent 
action.  The first issue is whether the circuit court erred in 
instructing the jury that Ms. Brown may be found contributorily 
negligent under Wis. Stat. § 448.30.  The jury found that Ms. 
Brown was contributorily negligent, that is, she failed to 
exercise ordinary care with regard to her own health and well-
being.  
                     
1 The plaintiffs sued a second physician, Dr. Steven D. 
Johnson.  The jury found that he was not causally negligent for 
Ms. Brown's injuries. Dr. Johnson and the companion parties, 
Meridian 
Resource 
Corporation 
on 
behalf 
of 
Benefit 
Plan 
Administrators Co., and Wisconsin Physicians Service-Medicare 
Part B, are not parties to this review. 
Neither the plaintiffs nor the defendants sought review of 
the jury's findings on damages. 
2 All subsequent references to the Wisconsin Statutes will 
be to the 1993-94 version unless otherwise noted. 
3 The Wisconsin Patients Compensation Fund no longer has any 
financial interest in the outcome of the case but filed an 
amicus brief arguing that a patient not be insulated from the 
consequences of his or her own negligence. 
No. 97-2181 
 
3 
¶4 
The second issue is whether the circuit court erred in 
failing to instruct the jury about defenses asserted by Dr. 
Dibbell under Wis. Stat. § 448.30.  The jury found Dr. Dibbell 
negligent with respect to obtaining Ms. Brown's informed consent 
to the surgery. 
¶5 
As to the first issue, we conclude that as a general 
rule patients have a duty to exercise ordinary care for their 
own health and well-being and that contributory negligence may, 
under certain circumstances, be a defense in an informed consent 
action.  We agree, however, with the court of appeals that the 
very patient-doctor relation assumes trust and confidence on the 
part of the patient and that it would require an unusual set of 
facts to render a patient guilty of contributory negligence when 
the patient relies on the doctor. 
¶6 
The more difficult question then is to define the 
dimensions of a patient's duty to exercise ordinary care for the 
patient's health and well-being under Wis. Stat. § 448.30.  The 
record in this case presents three aspects of a patient's duty.4 
 We examine each in turn and conclude that the circuit court 
erred 
in 
not 
tailoring 
the 
pattern 
jury 
instruction 
on 
contributory negligence as we describe below.  
¶7 
(1)  A patient's duty to exercise ordinary care in an 
informed consent action includes a patient's duty to tell the 
truth and give complete and accurate information about personal, 
family and medical histories to a doctor to the extent possible 
                     
4 The court of appeals noted that "we perceive defining the 
dimensions of a patient's duty in an informed consent case to be 
a virtually impossible task."  Brown v. Dibbell, 220 Wis. 2d 
200, 207, 582 N.W.2d 134 (Ct. App. 1998). 
No. 97-2181 
 
4 
in response to the doctor's requests for information when the 
requested 
information 
is 
material 
to 
the 
doctor's 
duty 
prescribed in Wis. Stat. § 448.30.  The jury should have been so 
instructed in the present case.  
¶8 
(2)  A patient's duty to exercise ordinary care in an 
informed consent action generally does not impose on the patient 
an affirmative duty to ascertain the truth or completeness of 
the information presented by the doctor; to ask questions of the 
doctor; or to independently seek information when a reasonable 
person would want such information.  We conclude that a patient 
usually has the right to rely on the professional skills and 
knowledge of a doctor.  We do not conclude, however, that a 
patient may never be contributorily negligent for failing to 
take such steps.  We merely conclude that it would require a 
very extraordinary fact situation for a jury to be instructed 
that a patient may be found contributorily negligent for relying 
on the information presented by the doctor, for failing to ask 
the doctor for information or for failing to independently seek 
information.  The evidence does not place this case in the realm 
of the extraordinary. 
¶9 
(3)  A 
patient 
does 
not, 
except 
in 
a 
very 
extraordinary fact situation, fail to exercise ordinary care for 
her health or well-being in an informed consent action when the 
patient chooses a viable medical mode of treatment presented by 
a doctor.  The evidence does not place this case in the realm of 
the extraordinary. 
¶10 As to the second issue presented in this case, we 
conclude that the circuit court erred in refusing to grant 
No. 97-2181 
 
5 
defendants' motion to instruct the jury about defenses set forth 
in Wis. Stat. § 448.30, when evidence suggesting such defenses 
was presented. 
¶11 We affirm the decision of the court of appeals that 
the cause be remanded to the circuit court for a new trial, but 
our rationale is different from that of the court of appeals. 
 
I 
 
¶12 These are the relevant facts for review.  At age 36, 
Marlene Brown sought the advice of her doctor, Dr. R.P. Alfuth 
of the Midelfort Clinic, for his opinion about a lump in her 
right breast.  Dr. Alfuth examined Ms. Brown and felt a possible 
cyst in her right breast.  He decided to obtain a mammogram and, 
because Ms. Brown had saline breast implants, sent her for a 
consultation with Dr. David Dibbell, a reconstructive surgeon at 
the Midelfort Clinic who was familiar with examining patients 
with breast implants.   
¶13 On June 17, 1993, Dr. Perry L. Kyser, a radiologist at 
the Midelfort Clinic, reported that Ms. Brown's mammogram showed 
a 
possible 
density 
in 
her 
right 
breast, 
that 
clinical 
confirmation was recommended, and that if clinical examination 
revealed no palpable abnormality in the right breast, then 
"follow-up 
of 
the 
right 
breast only 
in 
6 
months 
[was] 
suggested."   
¶14 On August 30, 1993, Ms. Brown consulted with Dr. 
Dibbell.  At trial, Dr. Dibbell testified that at this first 
consultation with Ms. Brown he reassured her that the lump she 
No. 97-2181 
 
6 
detected was actually a portion of her implant.  Ms. Brown told 
him that her twin sister had died three years previously from 
breast cancer, that her mother also had breast cancer, and that 
she had multiple other female relatives with the disease.  He 
testified that he explained to Ms. Brown that she was at "high 
risk" for developing breast cancer because of her family 
history, but that there was nothing to indicate that she had 
cancer.  Dr. Dibbell also testified that Ms. Brown repeatedly 
asked about treatment options despite his insistence that the 
discussion was premature until after he had consulted with the 
radiologists.  Dr. Dibbell stated that he reluctantly discussed 
with Ms. Brown the option of elective bilateral mastectomies 
because of her remarkable fear of developing breast cancer, her 
significant family history of the disease and the difficulty of 
assessing the lump because of her breast implants. 
¶15 Dr. Dibbell testified that shortly after this first 
consultation with Ms. Brown, he consulted with Dr. Kyser and 
another radiologist at the Midelfort Clinic.  According to Dr. 
Dibbell's testimony, the radiologists told him that they did not 
consider the lesion to be suspicious and that therefore it was 
reasonable to wait six months and take another mammogram of her 
right breast.  He also testified that the radiologists told him 
that biopsy by "needle localization" was not medically indicated 
because the needle might puncture her implant and that the 
procedure was otherwise futile because the lesion could not be 
localized by touch.   
¶16 On September 9, 1993, Dr. Dibbell saw Ms. Brown for a 
follow-up examination.  Dr. Dibbell physically re-examined Ms. 
No. 97-2181 
 
7 
Brown's right breast and again concluded that he felt nothing 
particularly suspicious.  Dr. Dibbell testified that he spent 40 
minutes at the September 9, 1993, consultation and discussed 
treatment options with Ms. Brown.  He stated that these 
discussions included the radiologists' opinions that it was 
reasonable to wait for six months and that needle localization 
was not appropriate.  Dr. Dibbell also testified that Ms. Brown 
refused the option of waiting for six months and then taking 
another mammogram because of her intense fear of developing 
breast cancer.  He explained to her that if she felt she had to 
do something, prophylactic bilateral mastectomies made better 
sense than many inconclusive biopsies.  
¶17 On September 15, 1993, Ms. Brown consulted with Dr. 
Johnson, a surgeon at Midelfort Clinic, who testified that Ms. 
Brown told him her twin sister, her mother and two aunts had 
breast cancer.  Dr. Johnson testified that he told Ms. Brown 
that she was in a high risk category of developing breast 
cancer.  Dr. Johnson testified that he informed Ms. Brown that 
he considered her two treatment options to be either a repeat 
mammogram in six months or prophylactic mastectomies. 
¶18 On November 1, 1993, Dr. Dibbell conducted a pre-
operative history and physical examination of Ms. Brown.  In his 
testimony, Dr. Dibbell stated that during this consultation he 
again advised Ms. Brown that there was no evidence that she had 
cancer and that her breasts would be smaller as a result of the 
surgery.  He said he advised her that this was a significant 
surgical procedure requiring general anesthesia. 
No. 97-2181 
 
8 
¶19 On November 3, 1993, Dr. Dibbell again spoke with Ms. 
Brown immediately before her surgery.  He testified at trial 
that he again reassured her that she did not have cancer, that 
if an implant broke he would replace it with a new one and that 
he would do everything possible to minimize her pain and ensure 
her safety and comfort during surgery. 
¶20 Ms. Brown testified that Dr. Dibbell never informed 
her that the radiologists had found nothing wrong with her right 
breast and that they had recommended a treatment plan of a 
follow-up mammogram in six months.  She also testified that Dr. 
Dibbell never discussed with her the option of seeking a biopsy 
by needle localization or any other alternative treatment plan. 
 Ms. Brown also testified that neither Dr. Dibbell nor Dr. 
Johnson could tell her whether she had breast cancer, but that 
they did tell her there was a high risk of her developing breast 
cancer and that bilateral mastectomies were the best way to 
reduce the risk. 
¶21 Following 
surgery, 
Ms. 
Brown 
experienced 
several 
problems including scarred breasts, asymmetrical nipples and 
areola, loss of sensation in her breasts, and other problems 
requiring additional surgeries.   
¶22 On February 25, 1995, the plaintiffs commenced this 
action alleging that Dr. Dibbell and Dr. Johnson had violated 
their duties under Wis. Stat. § 448.30 by failing to properly 
disclose to Ms. Brown the risks of, the possible alternatives to 
and the disadvantages of bilateral mastectomies, and by failing 
to advise Ms. Brown accurately of her post-operative appearance. 
 The plaintiffs claimed that Dr. Dibbell never discussed with 
No. 97-2181 
 
9 
Ms. Brown treatment options such as continued mammograms or 
waiting six months; that he incorrectly represented to her that 
the bilateral mastectomies would prevent the development of 
breast cancer; that he never told her or quantified her exact 
risk of developing breast cancer; and that he repeatedly 
reassured her that with postoperative reconstruction she would 
be as cosmetically pleasing in appearance as she had been prior 
to the mastectomies.   
¶23 The plaintiffs also brought medical malpractice claims 
against Dr. Dibbell and Dr. Johnson alleging that they were 
negligent in their duties as doctors for deciding to perform and 
then performing the bilateral mastectomies.  With regard to the 
losses sustained by Mr. Brown, the plaintiffs asserted a claim 
for loss of consortium, society and companionship due to the 
injuries sustained by Ms. Brown.5 
¶24 The jury found that Dr. Dibbell was negligent in 
obtaining Ms. Brown's consent to surgery; that Dr. Johnson was 
not negligent in obtaining Ms. Brown's consent to surgery; that 
neither doctor was negligent in rendering medical care to Ms. 
Brown; 
and 
that 
a 
reasonable 
patient 
in 
Ms. 
Brown's 
circumstances, if adequately informed, would have refused to 
                     
5 The plaintiffs further alleged that Ms. Brown suffered 
severe and catastrophic injuries, including severe temporary and 
permanent 
injuries; 
pain 
and 
suffering; 
disability; 
disfigurement; and loss of enjoyment of life.  They further 
alleged that she would experience great pain, suffering, 
disability, disfigurement and loss of enjoyment of life in the 
future.  In addition, the plaintiffs alleged that Ms. Brown 
incurred and would continue to incur substantial medical, 
hospital, drug and nursing expenses and miscellaneous related 
expenses, as well as lost wages and loss of earning capacity.  
No. 97-2181 
 
10
undergo the surgery that was performed.6  The jury awarded 
$150,000 in damages to Ms. Brown and $15,000 to Mr. Brown.  The 
jury, however, also found that Ms. Brown was causally negligent 
for failing to exercise ordinary care with respect to her own 
health and well-being.  The jury apportioned 50% causal 
negligence each to Dr. Dibbell and Ms. Brown.   
¶25 The parties brought several post-verdict motions.  
Among these were the plaintiffs' challenge to the jury finding 
of Ms. Brown's contributory negligence and the defendants' 
motion for a new trial on the ground that the circuit court 
refused to instruct the jury on the defendants' proposed jury 
instructions on various defenses.  The circuit court denied 
these post-verdict motions.  The court of appeals reversed the 
judgment of the circuit court and remanded the cause to the 
circuit court for a new trial. 
 
II 
 
¶26 The first issue is whether the circuit court erred in 
instructing the jury that Ms. Brown may be found contributorily 
negligent in this informed consent action under Wis. Stat. 
§ 448.30 (1993-94).  Contributory negligence is conduct by an 
injured party that falls below the standard to which a 
reasonably prudent person in that injured party's position 
should conform for his or her own protection and that is a 
legally contributing cause of the injured party's harm.  
                     
6 The claims against Dr. Johnson and the medical malpractice 
claim against Dr. Dibbell are not at issue in this appeal.  
No. 97-2181 
 
11
¶27 The 
circuit 
court 
gave 
the 
jury 
the 
pattern 
instruction on contributory negligence, which is a general 
instruction about failing to exercise ordinary care.  The jury 
found Dr. Dibbell negligent and Ms. Brown contributorily 
negligent.  It attributed 50% of the causal negligence to Dr. 
Dibbell with respect to obtaining Ms. Brown's informed consent 
to the surgery and 50% to Ms. Brown with respect to exercising 
ordinary care for her own health and well-being.  
¶28 The court of appeals examined various aspects of 
contributory negligence raised by the evidence in the record.  
The court of appeals held in the context of Wis. Stat. § 448.30 
that a patient would not be contributorily negligent by failing 
to investigate or question information provided by a doctor or 
to seek quantification of information about the risks involved 
in a particular treatment option.  The court of appeals 
concluded that in all but the most extraordinary instance, a 
patient 
could 
not 
be 
found 
contributorily 
negligent 
by 
consenting to a treatment or procedure that a doctor presents as 
a viable option.7  The court of appeals did not view the evidence 
in this case as presenting any such extraordinary instance.  
Finally, the court of appeals concluded that the evidence in the 
record does not sustain the jury's verdict that Ms. Brown was 
contributorily negligent.  
¶29 The 
availability 
and 
nature 
of 
a 
defense 
of 
contributory negligence are questions of law that this court 
                     
7 The court of appeals opinion is ambiguous because it can 
also be read as saying that the court of appeals hesitates to 
declare an absolute rule that a patient can never be negligent 
by failing to make sufficient inquiries of a doctor.   
No. 97-2181 
 
12
considers independent of the decisions of the circuit court and 
court of appeals, but benefiting from their analyses. 
¶30 To answer the question presented about the role of 
contributory negligence in an informed consent action, we turn 
first to the informed consent statute, Wis. Stat. § 448.30, 
which provides that "any physician who treats a patient shall 
inform the patient about the availability of all alternate 
viable medical modes of treatment and about the benefits and 
risks of these treatments."  Wisconsin Stat. § 448.30 in its 
entirety provides as follows: 
 
448.30  Information on alternate modes of treatment. 
Any physician who treats a patient shall inform the 
patient about the availability of all alternate, 
viable medical modes of treatment and about the 
benefits 
and 
risks 
of 
these 
treatments. 
 
The 
physician's duty to inform the patient under this 
section does not require disclosure of: 
 
(1)  Information beyond what a reasonably well-
qualified 
physician 
in 
a 
similar 
medical 
classification would know. 
 
(2)  Detailed technical information that in all 
probability a patient would not understand. 
 
(3)  Risks apparent or known to the patient.  
 
(4)  Extremely remote possibilities that might 
falsely or detrimentally alarm the patient. 
 
(5)  Information in emergencies where failure to 
provide treatment would be more harmful to the patient 
than treatment. 
 
(6)  Information in cases where the patient is 
incapable of consenting. 
 
¶31 The 
informed 
consent 
statute 
is 
silent 
about 
contributory negligence.  An action alleging a doctor's failure 
to adequately inform a patient is, however, grounded on a 
No. 97-2181 
 
13
negligence theory of liability.  Contributory negligence is 
generally a defense in an action based on a negligence theory of 
liability. 
¶32 The doctrine of informed consent focuses on the 
reasonableness of a doctor's disclosure.8  The standard regarding 
what a doctor must disclose is described as "the prudent patient 
standard."  To fulfill the doctor's duty under Wis. Stat. 
§ 448.30 a doctor must provide information that a reasonable 
person in the patient's position would want to know in order to 
make an informed decision with respect to the alternative 
choices of treatments or procedures.  That information includes 
"an assessment of and communication regarding 'the gravity of 
the patient's condition, the probabilities of success, and any 
alternative treatment or procedures if such are reasonably 
appropriate.'"  Johnson v. Kokemoor, 199 Wis. 2d 615, 632, 545 
N.W.2d 495 (1996) (quoting Scaria v. St. Paul Fire & Marine Ins. 
Co., 68 Wis. 2d 1, 11, 227 N.W.2d 647 (1975)).9  "The information 
that is reasonably necessary for a patient to make an informed 
                     
8 Johnson v. Kokemoor, 199 Wis. 2d 615, 629, 545 N.W.2d 495 
(1996); Martin v. Richards, 192 Wis. 2d 156, 171, 531 N.W.2d 70 
(1995); Trogun v. Fruchtman, 58 Wis. 2d 569, 600, 207 N.W.2d 297 
(1973). 
9 See also Martin, 192 Wis. 2d at 174.  As the court stated 
in Scaria v. St. Paul Fire & Marine Ins. Co., 68 Wis. 2d 1, 13, 
227 N.W.2d 647 (1975):  
In short, the duty of the doctor is to make such 
disclosures 
as 
appear 
reasonably 
necessary 
under 
circumstances then existing to enable a reasonable 
person 
under 
the 
same 
or 
similar 
circumstances 
confronting the patient at the time of disclosure to 
intelligently exercise his right to consent or to 
refuse the treatment or procedure proposed. 
 
No. 97-2181 
 
14
decision regarding treatment will vary from case to case."  
Martin v. Richards, 192 Wis. 2d 156, 175, 545 N.W.2d 495 
(1996).10 
¶33 There is little authority on the role of contributory 
negligence in informed consent actions.  The plaintiffs assert 
that the circuit court erred in giving the jury the pattern jury 
instruction on contributory negligence.11  They ask this court to 
                     
10 The circuit court gave the jury the following instruction 
on 
informed 
consent 
based 
on 
Wis 
JI—Civil 
§ 1023.2 
("Malpractice: Informed Consent"): 
A physician who proposes to perform an operation 
must make such disclosures as will enable a reasonable 
person under the circumstances confronting the patient 
to exercise the patient's right to consent to, or to 
refuse, the operation proposed. 
 
The doctor's disclosure must be sufficient to 
enable a reasonable person, situated as was the 
patient, to understand: his or her existing physical 
condition, the risks to his or her life or health 
which the operation imposes, and the purposes and 
advantages of the operation. 
 
The doctor must inform the patient whether the 
operation proposed is ordinarily performed in the 
circumstances 
confronting 
the 
patient, 
whether 
alternate 
procedures 
approved 
by 
the 
medical 
profession are available, what the outlook is for 
success or failure of each alternate procedure, and 
the risks inherent in each alternate procedure. 
 
11 The circuit court gave the jury the following instruction 
on 
contributory 
negligence 
based 
on 
Wis 
JI—Civil 
§ 1007 
("Contributory Negligence: Defined"): 
Every person in all situations has a duty to 
exercise ordinary care for his or her own safety.  
This does not mean that a person is required at all 
hazards to avoid injury; a person must, however, 
exercise ordinary care to take precautions to avoid 
injury to himself or herself. 
 
To be free of negligence, a person must exercise 
ordinary care in choosing his or her course of conduct 
No. 97-2181 
 
15
reverse the jury verdict regarding Ms. Brown's contributory 
negligence and to hold that Ms. Brown could not, as a matter of 
law, be found contributorily negligent.  
¶34 The defendants, on the other hand, argue that the 
circuit court's instruction on contributory negligence was 
correct.  They ask this court to reverse the court of appeals 
decision and reinstate the jury verdict finding Ms. Brown 
contributorily negligent.  
¶35 The defendants argue that the doctrine of contributory 
negligence applies to all negligence cases and that because 
informed consent actions are based on negligence liability, the 
doctrine of contributory negligence applies to informed consent 
actions.  They contend that no exception to the applicability of 
                                                                  
and in the pursuit of that choice.  A person is not 
guilty of negligence in making a choice of conduct if 
the person has no knowledge that one course of conduct 
carries a greater hazard than another, provided that 
such lack of knowledge is not the result of the 
person's failure to exercise ordinary care.  
 
On the basis of this instruction, the jury answered "yes" 
to the following question presented in the special verdict form: 
"Was the plaintiff, Marlene Brown, negligent in respect to her 
own health and well being?" 
With regard to this instruction, the circuit court made the 
following comments on the record: 
[J]ust assume that the Doctor did not give enough 
information to the person. . . .  At the same time, I 
think there's an argument that—I don't know if it's 
valuable, but it's possible that somebody could say, 
well, I consented to this operation.  I went ahead and 
let him do surgery because it's a two-person thing, 
and I . . . didn't bother even being informed about it 
properly ahead of time. . . .  The patient still has a 
duty of ordinary care to look out for her own well-
being . . . .  [I]f she did consent to the surgery 
without proper information, which is alleged, then she 
maybe did not exercise ordinary care for herself. 
No. 97-2181 
 
16
contributory negligence exists in Wis. Stat. § 448.30, and this 
court should not read an exception into that statute.  They rely 
on the Wisconsin Civil Jury Instruction Committee, which 
recognizes 
the 
applicability 
of 
comparative 
negligence 
principles 
in 
its 
comment 
to 
the 
informed 
consent 
jury 
instruction.  The comment states that "if there is a question of 
comparative negligence, use the form of Wis. JI-Civil 3290."  
Wis JI-Civil 1023.2 (1998).  In sum, the defendants argue that a 
doctor's statutory duty to inform a patient does not obviate a 
patient's duty to exercise ordinary care for his or her own 
health and well-being; rather a doctor and a patient have a 
joint 
responsibility 
to 
ensure 
that 
informed 
consent 
is 
obtained.  
¶36 We agree with the defendants that patients have a duty 
to exercise ordinary care for their own health and well-being; 
that contributory negligence, as a general rule, is an available 
defense in suits based on negligence; and that contributory 
negligence may, under certain circumstances, be a defense in an 
informed 
consent 
action 
because 
the 
action 
is 
based 
on 
negligence.  We thus recognize that a patient bringing an 
informed consent action is not exempt from the duty to exercise 
ordinary care for his or her own health and well-being.  We also 
agree, however, with the court of appeals that the very patient-
doctor relation assumes trust and confidence on the part of the 
patient and that it would require an unusual set of facts to 
render a patient guilty of contributory negligence when the 
patient relies on the doctor. 
No. 97-2181 
 
17
¶37 The more difficult question then is how to define the 
dimensions of a patient's duty to exercise ordinary care for the 
patient's health and well-being under Wis. Stat. § 448.30.  In 
other words, we must determine what conduct by a patient might 
constitute 
contributory negligence 
in 
an informed consent 
action.  
¶38 More specifically, as we stated previously, the record 
in this case presents three aspects of a patient's duty to 
exercise ordinary care for the patient's health and well-being. 
 The three aspects of a patient's duty to exercise ordinary care 
are as follows:  
¶39 (1)  Whether a patient's duty to exercise ordinary 
care in an informed consent action includes a patient's duty to 
tell the truth and give complete and accurate information about 
personal, family and medical histories to the doctor to the 
extent possible in response to the doctor's requests for 
information when the requested information is material to the 
doctor's duty prescribed in Wis. Stat. § 448.30.  The court of 
appeals did not address this question. 
¶40 (2)  Whether a patient's duty to exercise ordinary 
care in an informed consent action imposes an affirmative duty 
on the patient to ascertain the truth or completeness of the 
information presented by the doctor; to ask questions of the 
doctor; or to independently seek information when a reasonable 
patient would want such information.  
¶41 (3)  Whether a patient fails to exercise ordinary care 
for her health and well-being in an informed consent action when 
No. 97-2181 
 
18
the patient chooses a viable medical mode of treatment presented 
by a doctor. 
¶42 We examine each of these aspects of a patient's duty 
to exercise ordinary care in turn and conclude that the circuit 
court erred in not tailoring the pattern jury instruction about 
contributory negligence as we describe below. 
(1) 
¶43 The defendants urge that a patient's duty to exercise 
ordinary care in an informed consent action includes the 
patient's telling the truth to the doctor and giving complete 
and accurate information when the doctor asks about material 
personal, family and medical histories.12  They contend that the 
jury could have concluded that Ms. Brown falsely told the 
doctors that her mother had breast cancer; that Dr. Dibbell's 
advice to Ms. Brown that she had a high risk of developing 
breast cancer was based at least in part on Ms. Brown's 
misrepresentation; and that therefore the misrepresentation 
constituted negligence contributing to her injury.  
¶44 A patient is usually the primary source of information 
about the patient's material personal, family and medical 
histories.  If a doctor is to provide a patient with the 
information required by Wis. Stat. § 448.30, it is imperative 
that in response to a doctor's material questions a patient 
provide information that is as complete and accurate as possible 
under the circumstances.  We therefore conclude that for 
patients to exercise ordinary care, they must tell the truth and 
give complete and accurate information about personal, family 
                     
12 The court of appeals did not address this issue.  
No. 97-2181 
 
19
and medical histories to a doctor to the extent possible in 
response to the doctor's requests for information when the 
requested information is material to a doctor's duty as 
prescribed by § 448.30 and that a patient's breach of that duty 
might, under certain circumstances, constitute contributory 
negligence.13 
¶45 We therefore conclude that the circuit court in the 
present case should have given the jury an instruction on 
contributory negligence tailored to Ms. Brown's duty to exercise 
ordinary care in providing complete and accurate information to 
her doctors in response to their questions concerning personal, 
family and medical histories material to their duties prescribed 
in Wis. Stat. § 448.30. 
(2) 
¶46 The defendants urge that a patient's duty to exercise 
ordinary 
care 
in 
an 
informed 
consent 
action 
imposes 
an 
affirmative duty on a patient to ascertain the truth or 
completeness of the information presented by the doctor; to ask 
questions of the doctor; and to independently seek information 
when a reasonable patient would want to have such information.  
They contend that a jury may find a patient contributorily 
negligent if a reasonable patient would want to know certain 
information and the patient did not ask the doctor for that 
information or did not independently seek it out. 
                     
13 We do not address whether a patient's duty to exercise 
ordinary care requires the patient to volunteer information or 
to spontaneously advise the doctor of material personal, family 
or medical histories that the patient reasonably knows should be 
disclosed. 
No. 97-2181 
 
20
¶47 The defendants contend that the jury could have found 
Ms. Brown contributorily negligent because she failed to ask for 
brochures 
about 
mastectomies 
or 
photographs 
showing 
what 
patients look like after this kind of surgery.  According to the 
defendants, the jury could have found that a reasonable person 
in Ms. Brown's position would take these measures to ensure that 
she had enough information to make an informed decision.  
¶48 The defendants also assert that the jury could have 
found Ms. Brown contributorily negligent for failing to ask the 
doctor for more information about her risk of developing cancer. 
 They contend that a reasonable person in Ms. Brown's position 
who had been told she had a high risk of developing breast 
cancer would have asked about the statistical chance of 
developing breast cancer so she could make an informed decision. 
¶49 According to the plaintiffs, the defendants' position 
on contributory negligence is nothing more than an attempt to 
make patients cure the shortcomings of their doctors and to 
transform a doctor's duty to inform the patient into a patient's 
duty to seek information.  
¶50 The rationale underlying the doctrine of informed 
consent and a doctor's duty to inform a patient is that a 
patient has a right to decide whether to consent to or refuse a 
proposed course of treatment.  A patient cannot make an informed 
decision unless a doctor discloses information material to the 
patient's decision.14  Thus we conclude that generally in an 
informed consent action, a patient's duty to exercise ordinary 
care does not impose on the patient an affirmative duty to 
                     
14 Martin, 192 Wis. 2d at 174; Scaria, 68 Wis. 2d at 12-13. 
No. 97-2181 
 
21
ascertain the truth or completeness of the information presented 
by the doctor; nor does a patient have an affirmative duty to 
ask questions or independently seek information.  
¶51 We agree with the plaintiffs and the court of appeals 
that in most cases it is illogical and contrary to the concept 
of informed consent to place on patients the burden of asking 
questions of their doctors or engaging in their own independent 
research.  It is the doctor who possesses medical knowledge and 
skills and who has the affirmative duty under Wis. Stat. 
§ 448.30  both to determine what a reasonable patient in the 
position of Ms. Brown would want to know and to provide that 
material information.  The informed consent statute speaks 
solely in terms of the doctor's duty to disclose and discuss 
information related to treatment options and risks.  The 
informed consent statute recognizes that a patient is not in a 
position to know treatment options and risks and, if unaided, is 
unable to make an informed decision. 
¶52 For these reasons, we conclude that as a general rule 
a jury should not be instructed that a patient can be found 
contributorily negligent for failing to ask questions or for 
failing to undertake independent research.  A patient's duty to 
exercise ordinary care generally does not encompass a duty to 
ascertain the truth or the completeness of the information 
presented by a doctor.  Requiring patients either to ask 
questions or to independently seek information would erode a 
doctor's duty to obtain informed consent.  
¶53 We do not conclude, however, that a patient may never 
be contributorily negligent for failing to seek information.  It 
No. 97-2181 
 
22
would, however, require a very extraordinary fact situation to 
render a patient contributorily negligent when the patient 
accepts and trusts the information a doctor provides, because 
ordinarily a patient may  rely on the knowledge and skills of a 
doctor.  The evidence does not place the present case in the 
realm of the extraordinary. 
(3) 
¶54 The defendants urge that a patient's duty to exercise 
ordinary care in an informed consent action requires that a 
patient make a reasonable choice among the alternative viable 
medical modes of treatment presented by a doctor.  According to 
the defendants, a jury may find a patient contributorily 
negligent for choosing a viable mode of treatment presented by a 
doctor when that treatment contravenes the patient's concerns.   
¶55 In this case, the defendants argue that Ms. Brown was 
presented with two viable medical modes of treatment: surgery or 
periodic mammograms.  The surgery was highly disfiguring; 
periodic mammograms would involve no disfigurement.  Thus the 
defendants contend that Ms. Brown was contributorily negligent 
for proceeding with bilateral mastectomies, the most disfiguring 
and cosmetically displeasing treatment alternative, when she was 
very concerned about her appearance and placed tremendous 
importance on the size and shape of her breasts.  According to 
the defendants, the jury could have concluded that, on these 
facts, Ms. Brown's choice of surgery constituted contributory 
negligence. 
¶56 The plaintiffs respond that a patient cannot be held 
contributorily negligent simply for consenting to a viable 
No. 97-2181 
 
23
medical mode of treatment presented by a doctor.  They argue 
that the focus in an informed consent action is on a doctor's 
failure to provide the information that would permit a patient 
to choose among the viable medical modes of treatment and that a 
patient cannot, as a matter of law, be negligent for choosing a 
mode of medical treatment presented by a doctor as viable.   
¶57 We agree with the plaintiffs and hold, as did the 
court of appeals, that except in a very extraordinary fact 
situation, a patient is not contributorily negligent for 
choosing a viable medical mode of treatment presented by a 
doctor.  See Brown, 220 Wis. 2d at 206-7.  The evidence does not 
place this case in the realm of the extraordinary. 
No. 97-2181 
 
24
III 
 
¶58 The plaintiffs assert that the court of appeals erred 
in holding that the circuit court should have given jury 
instructions on defenses asserted by the defendants.  The 
circuit court refused to grant the defendants' requests for the 
following two jury instructions: (1) a jury instruction on the 
provisions of Wis. Stat. § 448.30 that relieve a doctor of the 
duty to inform the patient of certain information; and (2) a 
jury instruction consisting of the optional fourth paragraph of 
the pattern jury instruction on informed consent, Wis JI-Civil 
1023.2.   
¶59 The 
plaintiffs 
contend 
that 
the 
circuit 
court 
correctly refused to instruct the jury on these defenses because 
no evidence was presented at trial that raised these defenses.  
They further contend that the court of appeals erred in ordering 
a new trial on the ground that it was prejudicial error for the 
circuit court to refuse to give these jury instructions.  
¶60 The court of appeals explained its holding on the jury 
instruction issue as follows: 
 
We conclude that the court should have instructed the 
jury on the applicable exceptions to Dr. Dibbell's 
informed consent duty because the jury was probably 
misled as to the scope of the doctor's duty under the 
informed consent statute.  Specifically, the jury 
should 
have 
been 
charged 
with 
both 
the 
fourth 
paragraph of Wis. JI-Civil 1023.2 and the appropriate 
statutory exceptions under § 448.30, Stats., because 
neither necessarily subsumes the other.  The record 
demonstrates 
that 
Dibbell 
put 
forth 
evidence 
explaining 
why 
he 
declined 
to 
provide 
certain 
information to Brown.   
Brown, 220 Wis. 2d at 211-12. 
No. 97-2181 
 
25
¶61 The 
ultimate resolution of 
whether 
a 
particular 
instruction is appropriate turns on a review of the evidence.  
Johnson v. State, 85 Wis. 2d 22, 28, 270 N.W.2d 153 (1978).  
Accordingly, this court has held it to be error for a circuit 
court to refuse to instruct the jury on an issue that the 
evidence has raised, as well as for a circuit court to instruct 
on an issue that the evidence has not raised.  D.L. v. Huebner, 
110 Wis. 2d 581, 624, 329 N.W.2d 890 (1983).  However, where an 
instruction is erroneous and tends to mislead or probably 
misleads the jury, such misstatement of the law constitutes 
prejudicial error.  Leahy v. Kenosha Memorial Hosp., 118 Wis. 2d 
441, 452, 348 N.W.2d 607 (Ct. App. 1984).  
¶62 We therefore review the record in this case to 
determine 
whether 
these 
two 
requested 
jury 
instructions 
correctly state the law and whether evidence was introduced that 
would warrant the instructions requested by the defendants.  See 
Huebner, 110 Wis. 2d at 624. 
¶63 Wisconsin Stat. § 448.30 sets forth six types of 
information that a doctor does not have the duty to disclose to 
a patient.  The defendants assert that the jury should have been 
instructed that Dr. Dibbell was not required to disclose the 
following four types of information set forth in the statute.  
Their proposed jury instruction read as follows: 
 
The physician's duty to inform the patient . . . does 
not require disclosure of: 
 
(1) Information 
beyond 
what 
a 
reasonably 
well 
qualified 
physician 
in 
a 
similar 
medical 
classification would know; 
 
(2) Detailed 
technical 
information 
that 
in 
all 
probability a patient would not understand; 
No. 97-2181 
 
26
 
(3) Risks apparent or known to the patient; 
 
(4) Extremely remote possibilities that might falsely 
or detrimentally alarm the patient. 
 
¶64 This requested jury instruction correctly states the 
law; it repeats verbatim four of the express exceptions to 
disclosure listed in Wis. Stat. § 448.30.  The circuit court 
rejected these proposed jury instructions on the ground that 
none of the statutory exceptions would apply to the facts as 
presented at trial.  
¶65 At trial, Dr. Dibbell and other doctors testified that 
they did not provide Ms. Brown with statistical information on 
her risk of developing cancer because this information is 
confusing and misleading to patients.  The defendants contend 
that Dr. Dibbell presented an arguably reasonable explanation 
for his failure to disclose such statistics to Ms. Brown and 
that this evidence was sufficient for the circuit court to give 
the jury the requested statutory instruction that a doctor need 
not disclose detailed technical information that a patient would 
not likely understand. 
¶66 Further, Dr. Dibbell testified at trial that the 
description 
he 
gave 
Ms. 
Brown 
of 
the 
mastectomy 
procedureremoval of all breast tissue, the nipple and part of 
the areolawould convey to her that breast sensation would be 
diminished.  According to the defendants, Ms. Brown must have 
been aware that she would suffer diminished breast sensation 
because after the surgery virtually none of her breast tissue 
would remain.   
No. 97-2181 
 
27
¶67 We hold, as did the court of appeals, that the defense 
that the risk was apparent or known to Ms. Brown is a defense 
the 
jury 
could 
consider. 
 
As 
discussed 
previously, 
the 
plaintiffs assert that Dr. Dibbell had failed in his duty of 
disclosure by not advising Ms. Brown that after undergoing 
bilateral 
mastectomies 
she 
would 
have 
diminished 
breast 
sensation.  We hold, as did the court of appeals, that the 
evidence raised the issue of whether this was a risk apparent or 
known to Ms. Brown.  See Wis. Stat. § 448.30(3).  We hold, as 
did the court of appeals, that the circuit court erred in not 
instructing the jury on one or more of the statutory defenses 
requested by the defendants and that this error was prejudicial 
because the jury was probably misled about the scope of the 
defendants' duty under the informed consent statute. 
¶68 At the close of evidence at trial, the defendants also 
asked the circuit court to include in the jury instructions the 
optional fourth paragraph of the standard Wisconsin informed 
consent instruction, Wis JI-Civil 1023.2.  This paragraph 
explains that a doctor may be justified in failing to make 
disclosures to a patient and reads as follows: 
 
 
If the doctor comes forward and offers to you an 
explanation as to why the doctor did not make a 
particular disclosure or disclosures to the plaintiff, 
and if such explanation satisfies you that it was 
reasonable for the doctor not to have made such 
disclosures, then you will find that the defendant did 
not fail in the duties owed by the doctor to the 
patient. 
 
¶69 The 
plaintiffs 
appear 
to 
contend 
that 
the 
six 
statutory exceptions listed in Wis. Stat. § 448.30 are the only 
explanations a doctor may offer for not disclosing information 
No. 97-2181 
 
28
to a patient and therefore the optional fourth paragraph should 
not have been given.  
¶70 The defendants assert that an instruction on a non-
statutory defense should have been given in this case.  They 
point out, for example, that the jury could have found that Dr. 
Dibbell's explanation of his failure to provide Ms. Brown with 
statistical information on her risk of developing breast cancer 
because the information would be misleading and confusing was a 
reasonable explanation for nondisclosure from the perspective of 
a patient, even if this court were to conclude that the 
explanation does not fit within the express exceptions set forth 
in Wis. Stat. § 448.30.   
¶71 The duty to disclose varies from case to case and 
"defies simple definition," Johnson, 199 Wis. 2d at 639; 
correspondingly, defenses may also vary.  We are therefore 
unwilling to hold that the legislature intended to categorically 
limit the defenses available to a doctor to those set forth in 
Wis. Stat. § 448.30.  A circuit court should, however, be 
cautious 
about 
instructing 
on 
defenses 
beyond 
those 
the 
legislature has expressly provided.  It should give the jury an 
instruction on defenses in addition to or in lieu of the 
statutory 
provisions 
only 
when 
evidence 
of 
a 
specific 
explanation for nondisclosure has been offered at trial and 
should craft the jury instruction to fit the evidence presented 
and the rule of law described below. 
¶72 The plaintiffs also argue that the optional fourth 
paragraph of Wis JI-Civil 1023.2 is a misleading statement of 
the law of informed consent.  Specifically, they contend that 
No. 97-2181 
 
29
the fourth paragraph is misleading because it allows a jury to 
excuse a doctor's breach of the duty to disclose if the doctor 
provides any explanation that the jury considers reasonable. 
¶73 We agree with the plaintiffs that the optional fourth 
paragraph of Wis JI-Civil 1023.2 is misleading.  The instruction 
does not make clear, as it should, that the reasonableness of a 
doctor's explanation for failure to disclose information must be 
measured from the perspective of what a reasonable person in the 
patient's position would want to know.  A doctor has an 
affirmative duty to disclose information that a reasonable 
person in the patient's position would want to know.15 
¶74 In other words, the optional fourth paragraph is 
misleading because it can be construed as stating that the 
question of a doctor's failure to disclose information is to be 
answered from the doctor's perspective.  The paragraph states 
that "if such explanation [provided by the doctor] satisfies you 
that it was reasonable for the doctor not to have made such 
disclosures, you will find that the defendant did not fail in 
the duties owed by the doctor to the patient."  Wis JI-Civil 
1023.2.  Determining the reasonableness of the nondisclosure 
from the perspective of what a doctor believes should be 
disclosed, instead of what a reasonable patient wants to know, 
is an erroneous statement of the law of informed consent.   
¶75 An instruction should make clear that for a jury to 
find that a doctor did not fail in the duty of disclosure owed 
by the doctor to the patient, a doctor must satisfy the jury 
                     
15 Schreiber v. Physicians Ins. Co., 223 Wis. 2d 417, 427, 
588 N.W.2d 26 (1999); Johnson, 199 Wis. 2d at 632; Martin, 192 
Wis. 2d at 174; Scaria, 68 Wis. 2d at 12-13. 
No. 97-2181 
 
30
that a reasonable patient under the circumstances then existing 
would not want to know the information the doctor failed to 
disclose.   
¶76 In summary, we agree with the defendants, as did the 
court of appeals, that the circuit court erred in refusing to 
grant the defendants' motion to instruct the jury about defenses 
set forth in Wis. Stat. § 448.30, when evidence suggesting such 
defenses was presented.  We also conclude that the language of 
the optional fourth paragraph of the informed consent jury 
instruction, Wis JI-Civil 1023.2, is misleading and should not 
have been given in the form proposed by the defendants.   
¶77 For the reasons set forth, we affirm the decision of 
the court of appeals and remand the cause for a new trial. 
By the Court.—The decision of the court of appeals is 
affirmed. 
 
No. 97-2181 
 
1