Opinion ID: 1387022
Heading Depth: 3
Heading Rank: 2

Heading: The Patient-Oriented Standard Governs the Physician's Duty to Disclose Risk Information Prior to Treatment

Text: Ideally, and in the abstract, the physician-oriented standard i.e., what a reasonable physician believes should be disclosed to a patient prior to treatment in order for the patient to make an informed and intelligent decision regarding a course of treatment or surgeryand the patient-oriented standard  i.e., what a reasonable patient needs to hear from his or her physician in order to make an informed and intelligent decision regarding treatment or surgerywould dictate the same scope of disclosure, barring the applicability of any of the exceptions to a physician's duty to disclose. We must assume, for purposes of fashioning a prospective rule, that physicians seek to provide their patients with the same amount and quality of risk information prior to treatment that the patient would need to hear in order to make an informed and intelligent choice. Both standards, therefore, tempered by objectivity, seek to achieve the same goal, that is, to insure that the patient's decision to undergo a particular medical procedure is an informed and intelligent decision. The dispositive issue, therefore, is one of proof; in other words, which party's viewpoint should dictate the standard against which the conduct in issue should be judged? The Bernard court provided the following rationale: Courts which apply [the patient-oriented] standard emphasize what the patient needs to know to make an informed decision, rather than what the medical community thinks the patient should be told.... [The patient-oriented] standard provides the patient with effective protection against a possible conspiracy of silence wherever it may exist among physicians. Moreover, since the patient must suffer the consequences, and since he or she bears all the expenses of the medical treatment, fundamental fairness requires that the patient be allowed to know what risks a proposed treatment entails, what the alternatives thereto are and the relative probabilities of success. Id., 79 Hawai`i at 381, 903 P.2d at 686 (internal quotation marks and citations omitted). Analogously, the Canterbury court reasoned as follows: The duty to disclose ... arises from phenomena apart from medical custom and practice. The latter, we think, should no more establish the scope of the duty than its existence. Any definition of scope in terms purely of a professional standard is at odds with the patient's prerogative to decide on projected therapy himself [or herself]. That prerogative, we have said, is at the very foundation of the duty to disclose, and both the patient's right to know and the physician's correlative obligation to tell ... are diluted to the extent that its compass is dictated by the medical profession. Canterbury, 464 F.2d at 786. We agree. We believe that the patient-oriented standard of disclosure better respects the patient's right of self-determination and affixes the focus of the inquiry regarding the standard of disclosure on the motivating force and purpose of the doctrine of informed consent aiding the individual patient in making an important decision regarding medical care. It also protects against the pitfalls of proof associated with the physician-oriented standard discussed in Canterbury. Moreover, not only should the patient's decision remain at the forefront when assessing the physician's disclosure to his or her patient in each case, but we also believe that, barring situations where the therapeutic privilege exception to the physician's duty to disclose is applicable, what the medical community believes the patient needs to hear in order for the patient to make an informed decision is insufficient, without more, to resolve the question of what an individual patient reasonably needs to hear in order for that patient to make an informed and intelligent choice regarding the proposed medical treatment. Therefore, in view of: (1) the fact that Nishi was decided without the benefit of the Canterbury decision; (2) the codification of Hawai`i's doctrine of informed consent; and (3) the growing nationwide trend favoring the patient-oriented standard, see generally 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, §§ 3, 6-7 (1979 and Supp. 1995), we agree with the ICA's application of the patient-oriented standard to the physician's duty to disclose risk information prior to treatment in Bernard. [5] We therefore expressly adopt the patient-oriented standard applicable to a physician's duty to disclose risk information prior to treatment, and, to the extent that Nishi may be construed otherwise, it is overruled. [6] The dispositive inquiry regarding the physician's duty to disclose in an informed consent case, therefore, is not what the physician believes his or her patient needs to hear in order for the patient to make an informed and intelligent decision; the focus should be on what a reasonable person objectively needs to hear from his or her physician to allow the patient to make an informed and intelligent decision regarding proposed medical treatment. We strongly caution, however, as did the ICA in Bernard, that our adoption of the patient-oriented standard does not relieve plaintiffs of their burden to provide expert medical testimony as to the materiality of the risk; to the contrary, a plaintiff maintains the burden of adducing expert medical testimony to establish the nature of risks inherent in a particular treatment, the probabilities of therapeutic success, the frequency of the occurrence of particular risks, and the nature of available alternatives to treatment. Bernard, 79 Hawai`i at 383, 903 P.2d at 688 (quotation marks, internal brackets, and citation omitted). As the Canterbury court noted: Experts are ordinarily indispensable to identify and elucidate for the factfinder the risks of therapy and the consequences of leaving existing maladies untreated. They are normally needed on issues as to the cause of any injury or disability suffered by the patient and, where privileges are asserted, as to the existence of any emergency claimed and the nature and seriousness of any impact upon the patient from risk-disclosure. Save for relative[ly] infrequent instances where questions of this type are resolvable wholly within the realm of ordinary human knowledge and experience, the need for the expert is clear. 464 F.2d at 791-92 (footnote omitted). Therefore, the net prospective effect of our holding today is that a plaintiff's case will not fail for lack of expert medical testimony regarding the prevailing standard of disclosure in the medical community for a particular medical procedure or treatment. [7]