Opinion ID: 1154871
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Heading: The Doctrine of Informed Consent

Text: Alaska Statute 09.55.556(a) provides that a physician is liable for failure to obtain the informed consent of a patient if the claimant establishes by a preponderance of the evidence that the provider has failed to inform the patient of the common risks and reasonable alternatives to the proposed treatment or procedure, and that but for that failure the claimant would not have consented to the proposed treatment or procedure. AS 09.55.556(a). Although AS 09.55.556(a) states that a physician must disclose the common risks and reasonable alternatives to a proposed procedure, it does not set forth the standard by which this disclosure should be measured. [3] The legislative history is similarly silent on this issue. This is a question of first impression in Alaska. [4] Traditionally, a physician's duty to disclose information concerning treatment has been measured by the professional standard in the field. See, e.g., Potter v. Wisner, 170 Ariz. 331, 333, 823 P.2d 1339, 1341 (App. 1991); Jacobs v. Painter, 530 A.2d 231 (Me. 1987). See generally Laurent B. Fantz, Annotation, Modern Status of Views as to General Measure of Physician's Duty to Inform Patient of Risks of Proposed Treatment, 88 A.L.R.3d 1008, 1020-27 (1978). This rule reflects the belief that holding a physician to a lay standard of disclosure would interfere with the flexibility a physician must have in determining what therapy would best suit the patient's needs. See Ross v. Hodges, 234 So.2d 905, 908-09 (Miss. 1970). In order to establish a prima facie case, a plaintiff must usually present expert testimony of the professional standard of disclosure in the community and of the physician's failure to meet that standard. See Culbertson v. Mernitz, 602 N.E.2d 98, 102-04 (Ind. 1992) (expert testimony of professional standard of disclosure required except where deviation from the standard of care is a matter commonly known to lay persons); see also Daniel E. Feld, Annotation, Necessity and Sufficiency of Expert Evidence to Establish Existence and Extent of Physician's Duty to Inform Patient of Risks of Proposed Treatment, 52 A.L.R.3d 1084, 1091-92 (1973). However, the modern trend is to measure the physician's duty of disclosure by what a reasonable patient would need to know in order to make an informed and intelligent decision. The Louisiana Supreme Court has articulated this standard as follows: The informed consent doctrine is based on the principle that every human being of adult years and sound mind has a right to determine what shall be done to his or her own body. Surgeons and other doctors are thus required to provide their patients with sufficient information to permit the patient to make an informed and intelligent decision on whether to submit to a proposed course of treatment. Where circumstances permit, the patient should be told the nature of the pertinent ailment or condition, the general nature of the proposed treatment or procedure, the risks involved in the proposed treatment or procedure, the prospects of success, the risks of failing to undergo any treatment or procedure at all, and the risks of any alternate methods of treatment. Hondroulis v. Schuhmacher, 553 So.2d 398, 411 (La. 1989) (citations omitted). See generally Fantz, supra, at 1034-43. Under this modern view, expert testimony concerning the professional standard of disclosure is not a necessary element of the plaintiff's case because the scope of disclosure is measured from the standpoint of the patient. Our recent comments on the nature of the physician-patient relationship echo the concerns outlined by the Hondroulis court. The physician-patient relationship is one of trust. Because the patient lacks the physician's expertise, the patient must rely on the physician for virtually all information about the patient's treatment and health. A physician therefore undertakes, not only to treat a patient physically, but also to respond fully to a patient's inquiry about his treatment, i.e., to tell the patient everything that a reasonable person would want to know about the treatment. Pedersen v. Zielski, 822 P.2d 903, 909 (Alaska 1991) (citations omitted). We are persuaded that the modern view is the better rule and hold that the scope of disclosure required under AS 09.55.556(a) must be measured by what a reasonable patient would need to know in order to make an informed and intelligent decision about the proposed treatment. Under the reasonable patient rule, a physician must disclose those risks which are material to a reasonable patient's decision concerning treatment. See Hondroulis, 553 So.2d at 411; Canterbury v. Spence, 464 F.2d 772 (D.C. Cir.1972), cert. denied, 409 U.S. 1064, 93 S.Ct. 560, 34 L.Ed.2d 518 (1972). The determination of materiality is a two-step process. The first step is to define the existence and nature of the risk and the likelihood of its occurrence. Some expert testimony is necessary to establish this aspect of materiality because only a physician or other qualified expert is capable of judging what risk exists and the likelihood of its occurrence. The second prong of the materiality test is for the trier of fact to decide whether the probability of that type of harm is a risk which a reasonable patient would consider in deciding on treatment. The focus is on whether a reasonable person in the patient's position would attach significance to the specific risk. This determination does not require expert testimony. Hondroulis, 553 So.2d at 412. We also note that, in certain circumstances, a physician's failure to disclose a risk may be privileged. [T]he physician retains a qualified privilege to withhold information on therapeutic grounds, as in those cases where a complete and candid disclosure of possible alternatives and consequences might have a detrimental effect on the physical or psychological well-being of the patient, or where the patient is incapable of giving his consent by reason of mental disability or infancy, or has specifically requested that he not be told. Likewise the physician's duty to disclose is suspended where an emergency of such gravity and urgency exists that it is impractical to obtain the patient's consent. Finally disclosure is not required where the risk is either known to the patient or is so obvious as to justify presumption of such knowledge, nor is the physician under a duty to discuss the relatively remote risks inherent in common procedures, when it is common knowledge that such risks inherent in the procedure are of very low incidence. Conversely, where the physician does not know of a risk and should not have been aware of it in the exercise of ordinary care, he is under no obligation to make disclosure. Sard v. Hardy, 281 Md. 432, 379 A.2d 1014, 1022-23 (1977); Canterbury, 464 F.2d at 788-79; see generally Alan Meisel, The Exceptions to the Informed Consent Doctrine: Striking a Balance between Competing Values in Medical Decision-making, 1979 Wis.L.Rev. 413. As noted by the courts which have examined this issue, the burden of going forward with evidence pertaining to a privilege rests on the physician in whose hands the necessary evidence ordinarily rests. See Hondroulis, 553 So.2d at 413; Canterbury, 464 F.2d at 791.