Opinion ID: 2080579
Heading Depth: 2
Heading Rank: 1

Heading: Scope of Disclosure Duty

Text: Although it is well settled that the law imposes on a physician a general duty reasonably to disclose to his patient significant information concerning treatment, jurisdictions differ on the scope of this disclosure obligation. Many courts hold that the duty of a physician to make adequate disclosure is, as in other cases of medical malpractice, measured by the standard of the reasonable medical practitioner under the same or similar circumstances. Under this professional disclosure standard, therefore, whether and to what extent a physician has an obligation to disclose a particular risk must in most cases be determined by expert medical testimony establishing the prevailing standard of practice and the defendant's departure therefrom. See, e. g., Roberts v. Young, 369 Mich. 133, 139, 119 N.W.2d 627, 630 (1963); Collins v. Itoh, 160 Mont. 461, 469, 503 P.2d 36, 41 (1972); Folger v. Corbett, 118 N.H. 737, 738, 394 A.2d 63, 63-64 (1978); Wilson v. Scott, 412 S.W.2d 299, 301-02 (Tex.1967). On the other hand, an increasing number of courts hold that because a physician's obligation to disclose therapeutic risks and alternatives arises from the patient's right of physical self-determination, the disclosure duty should be measured by the patient's need for information rather than by the standards of the medical profession. These courts reason that physicians have a legal obligation adequately to disclose risk and option information that is material to the patient's decision to undergo treatment and that expert testimony as to medical standards is not required to establish this duty. Under this material-risk standard, although expert medical testimony may be necessary to establish the undisclosed risk as a known danger of the procedure, the jury can decide without the necessity of a medical expert whether a reasonable person in the patient's position would have considered the risk significant in making his decision. See, e. g., Canterbury v. Spence, 464 F.2d 772, 786-87 (D.C.Cir.), cert. denied, 409 U.S. 1064, 93 S.Ct. 560, 34 L.Ed.2d 518 (1972); Cobbs v. Grant, 8 Cal.3d 229, 243-45, 502 P.2d 1, 10-11, 104 Cal.Rptr. 505, 514-15 (1972); Sard v. Hardy, 281 Md. 432, 439-445, 379 A.2d 1014, 1020-22 (1977); Wilkinson v. Vesey, 110 R.I. 606, 620-626, 295 A.2d 676, 686-88 (1972). [4] A basic principle of medical malpractice law is that the physician is not an insurer. A poor result, standing alone, is insufficient to establish liability. Downer v. Veilleux, supra, 322 A.2d at 87. Thus, under no view of the doctrine of informed consent can liability be found for every failure to disclose a risk that has later materialized; despite solicitude for the informational needs of patients, liability for nondisclosure must still be based on fault. Underlying the conflict in the cases is a disagreement over the fundamental question whether fault in informed consent actions should be predicated on deviation from the professional standard of care or on interference with a patient's interest in physical self-determination. See generally 2 D. Louisell & H. Williams, Medical Malpractice ¶ 22.08 (1979). Consistent with our view of informed consent as a form of professional malpractice, we believe that fault must be measured by reference to the reasonable medical practitioner in the same branch of medicine and not according to some variable lay standard of materiality. [5] When a patient alleges that an unrevealed hazard has caused him injury, the jury must determine whether, under the facts of the case, the physician has deviated from the standard of care of the reasonable practitioner. Although the unreasonableness of a particular nondisclosure may be `sufficiently obvious as to lie within common knowledge . . .,' [6] Cox v. Dela Cruz, Me., 406 A.2d 620, 622 (1979), quoting Cyr v. Giesen, 150 Me. 248, 252, 108 A.2d 316, 318 (1954), in most cases expert medical testimony is just as necessary to establish negligence in failing adequately to disclose as it is to prove negligence in diagnosis or treatment. Whether the physician has acted unreasonably is often a question of professional judgment. In determining whether and how much he should disclose, the physician must consider the probable impact of disclosure on the patient, taking into account his peculiar knowledge of the patient's psychological, emotional and physical condition, and must evaluate the magnitude of the risk, the frequency of its occurrence and the viability of alternative therapeutic measures. See, e. g., Patrick v. Sedwick, 391 P.2d 453, 458 (Alas.1964); Grosjean v. Spencer, 258 Iowa 685, 692-95, 140 N.W.2d 139, 144-45 (1966). This determination involves medical judgment as to whether disclosure of possible risks may have such an adverse effect on the patient as to jeopardize success of the proposed therapy, no matter how expertly performed. Aiken v. Clary, 396 S.W.2d 668, 674 (Mo.1965). [7] Conceivably, full disclosure under some circumstances could constitute bad medical practice. Collins v. Meeker, 198 Kan. 390, 397, 424 P.2d 488, 495 (1967); see McCoid, The Care Required of Medical Practitioners, in Professional Negligence 13, 60-61 (T. Roady & W. Anderson ed. 1960). Moreover, a rule that allows a plaintiff to establish the existence and extent of the defendant-physician's disclosure obligation without regard to medical standards hardly diminishes the importance of expert medical testimony or absolves the plaintiff from producing such evidence on other issues in the case. The courts that have adopted this rule recognize the necessity, in the usual case, of medical evidence to identify the known risks of treatment, the nature of available alternatives and the cause of any injury or disability suffered by the plaintiff, e. g., Canterbury v. Spence, supra, 464 F.2d at 791-92; Sard v. Hardy, supra, 281 Md. at 447, 379 A.2d at 1024, and would allow the defendant to show by expert testimony that his conduct comported with medical standards, e. g., Sard v. Hardy, supra, 281 Md. at 445, 379 A.2d at 1023; Wilkinson v. Vesey, supra, 110 R.I. at 624, 295 A.2d at 688; see note 7 supra. [8] Furthermore, when the patient also claims negligent diagnosis or treatment, he will have secured medical experts to testify to the applicable standard of care. Bly v. Rhoads, 216 Va. 645, 649, 222 S.E.2d 783, 787 (1976). It certainly adds little to the burden of the plaintiff on his informed consent claim to require him to produce medical evidence that the physician's nondisclosure departed from prevailing standards of practice. Id. at 651, 222 S.E.2d at 788. In addition, we are not unmindful of the practical implications of dispensing with the requirement of expert medical testimony to establish the existence and extent of the disclosure duty in a given case. Inherent in such a rule is the potential danger that a jury, composed of laymen and gifted with the benefit of hindsight, will divine the breach of a disclosure obligation largely on the basis of the unfortunate result. In Bly v. Rhoads, supra , the Virginia court expressed a similar concern: The matters involved in the disclosure syndrome, more often than not, are complicated and highly technical. To leave the establishment of such matters to lay witnesses, in our opinion, would pose dangers and disadvantages which far outweigh the benefits and advantages a `modern trend' rule would bestow on patient-plaintiffs. In effect, the relaxed `modern trend' rule permits lay witnesses to express, when all is said and done, what amounts to a medical opinion. 216 Va. at 650, 222 S.E.2d at 787. Finally, we believe that legal principles designed to provide compensation to persons injured by bad professional practice should not unduly intrude upon the intimate physician-patient relationship. Although the material-risk theory may make it easier for some plaintiffs to recover, it does so by placing good medical practice in jeopardy. The physician's attention must be focused on the best interests of his patient and not on what a lay jury, unschooled in medicine, may, after the fact, conclude he should have disclosed. As a North Carolina court noted, [t]o adopt the [material-risk standard] would result in requiring every doctor to spend much unnecessary time in going over with every patient every possible effect of any proposed treatment. The doctor should not have to practice his profession with the knowledge that every consultation with every patient with respect to future treatment contains a potential lawsuit and his advice and suggestions must necessarily be phrased with the possible defense of a lawsuit in mind. This would necessarily result in the doctor's inability to give the best interest of his patient primary importance. Butler v. Berkeley, 25 N.C.App. 325, 342, 213 S.E.2d 571, 581-82 (1975). We hold, therefore, that the scope of a physician's duty to disclose is measured by those communications a reasonable medical practitioner in that branch of medicine would make under the same or similar circumstances and that the plaintiff must ordinarily establish this standard by expert medical evidence. [9]