Opinion ID: 1970225
Heading Depth: 1
Heading Rank: 2

Heading: the loss of chance doctrine

Text: The only decision of this Court to discuss the loss of chance doctrine is Shively v. Klein, Del.Supr., 551 A.2d 41 (1988). In Shively, the parents of a deceased child brought a wrongful death suit against a doctor alleging that the doctor committed medical malpractice by failing to diagnose and treat properly the child's illness. The jury returned a verdict in favor of the doctor and the Superior Court denied the plaintiffs' motions for judgment notwithstanding the verdict and new trial. The plaintiffs appealed claiming, inter alia, that a loss of chance instruction should have been included in the jury charge. This Court began its analysis of this claim by stating the usual negligence rule: To prove proximate cause, the plaintiff has to show that the doctor's negligence was the probable cause of the injury. In quantifiable terms, probable is any likelihood greater than 50 percent. Id. at 43 (emphasis in original). After describing the differing approaches to the loss of chance doctrine, the Court observed that adopting the instruction proposed by the plaintiffs in Shively would have been a drastic departure from the causation standards consistently applied in Delaware. Id. at 44. The Court concluded, however, that it need not rule on the validity of the loss of chance doctrine because the plaintiffs had not pleaded that theory of recovery: While we do not here rule out entirely the possible applicability of the doctrine in an appropriate case in Delaware, we note that it is important that any such innovative theory of negligence be pleaded with particularity and taken up at the pretrial conference so that the opposing side has the appropriate knowledge of the issue and the court has a chance to consider it. We also note that a change in the law of the magnitude suggested by plaintiffs would be an appropriate subject of legislation. Id. (citation omitted). [3] Thus, Delaware law is undeveloped. In this case, it is not necessary for us to explicate what the law would be in a hypothetical personal injury or survival action. It is appropriate in our view, however, that we explore the national state of the law in order to decide the certified question in the proper framework. The loss of chance doctrine has been the subject of considerable debate among courts and commentators. The controversy has been fueled, in part, by disagreements over the nature and effect of the doctrine. In general, there appear to be three approaches that courts have adopted when addressing the loss of chance doctrine. The first approach is to reject the doctrine as being contrary to traditional principles of tort causation (the traditional approach). The second approach is to adopt the doctrine as an exception to traditional causation standards (the relaxed causation approach). The third approach is to adopt the doctrine as a method of compensating the lost chance of survival, rather than the death itself (the proportional approach). Under the proportional approach, the victim is entitled to a portion of the total amount of death-related damages reflecting the reduction of the victim's chance of survival.
One of the leading decisions reflecting the traditional approach is Cooper v. Sisters of Charity of Cincinnati, Inc., 27 Ohio St.2d 242, 272 N.E.2d 97 (1971). In rejecting the loss of chance doctrine, the Ohio Supreme Court held: Lesser standards of proof are understandably attractive in medical malpractice cases where physical well being, and life itself, are the subject of litigation. The strong intuitive sense of humanity tends to emotionally direct us toward a conclusion that in an action for wrongful death an injured person should be compensated for the loss of any chance of survival, regardless of its remoteness. However, we have trepidations that such a rule would be so loose that it would produce more injustice than justice. Even though there exists authority for a rule allowing recovery based upon proof of causation by evidence not meeting the standard of probability, we are not persuaded by their logic. We consider the better rule to be that in order to comport with the standard of proof of proximate cause, plaintiff in a malpractice case must prove that defendant's negligence, in probability, proximately caused the death. Id. 272 N.E.2d at 103 (citations omitted). A substantial number of other jurisdictions have similarly decided not to adopt the loss of chance doctrine based on its apparent inconsistency with traditional causation standards. See Lisa Perrochet, Sandra J. Smith, and Ugo Colella, Lost Chance Recovery and the Folly of Expanding Medical Malpractice Liability, 27 Tort & Ins.L.J. 615, 629-32 (1992) (hereinafter cited as Perrochet) (listing 20 states that have refused to adopt the loss of chance doctrine). Nevertheless, one commentator has observed that a definite judicial trend recognizing lost chance of survival or recovery has developed. Darrell L. Keith, Loss of Chance: A Modern Proportional Approach to Damages in Texas, 44 Baylor L.Rev. 759, 769 (1992).
The relaxed causation approach was recently discussed by the Kansas Supreme Court in Delaney v. Cade, 255 Kan. 199, 873 P.2d 175 (1994). The Delaney Court explained that: the loss of chance theory is, essentially, one that allows an injured plaintiff to recover damages based upon a reduced standard of causation rather than the traditional one which requires the plaintiff to prove that it is more probable than not that the damage suffered was caused by the negligence of the defendant. Id. 873 P.2d at 183. A significant number of courts adopting the doctrine have done so using the relaxed causation approach. [4] See Perrochet, 27 Tort & Ins.L.J. at 624, 632-33 (listing seven jurisdictions adopting a reduced causation standard); see also John D. Hodson, Annotation, Medical Malpractice: Loss of Chance Causality, 54 A.L.R.4th 10 (1987).
The proportional approach reflects a somewhat different perspective on the question of compensating loss of chance. One author has explained the proportional approach and its rationale as follows: The current causation approach requires the finder of fact to determine whether the decedent's chances to live or to achieve a more favorable result were more probable than not. Once the evidence shows that a probability did or did not exist, the inquiry ends. As a result, chances of less than fifty-one percent are treated as if they were nonexistent. A more sensible approach would be to redefine the victim's injury as the loss of a chance. Instead of attempting to determine whether the physical harm was caused by negligence, a court could examine the extent of the victim's lost chances for cure or improvement and grant a recovery that mirrors the extent of those chances. When viewing the question in the negligence setting, the harm suffered would be the loss of the chance. The relevant inquiry would be whether the defendant probably caused a reduction in the victim's chances. If causation were found, the court would provide compensation for the lost chance in direct proportion to the extent of the lost chance. Stephen F. Brennwald, Comment, Proving Causation in Loss of a Chance Cases: A Proportional Approach, 34 Cath.U.L.Rev. 747, 766-67 (1985) (hereinafter cited as Brennwald) (footnotes omitted). The origins of the proportional approach lay in a thought-provoking and frequentlycited article by Professor Joseph King. See Joseph H. King, Jr., Causation, Valuation, and Chance in Personal Injury Torts Involving Preexisting Conditions and Future Consequences, 90 Yale L.J. 1353 (1981) (hereinafter cited as King). In his article, Professor King focused on the nature of the injury in a loss of chance case and on the proper method of valuing damages. Professor King's thesis was that: the loss of a chance of achieving a favorable outcome or of avoiding an adverse consequence should be compensable and should be valued appropriately, rather than treated as an all-or-nothing proposition. Preexisting conditions must, of course, be taken into account in valuing the interest destroyed. When those preexisting conditions have not absolutely preordained an adverse outcome, however, the chance of avoiding it should be appropriately compensated even if that chance is not better than even. Id. at 1354. A number of courts and commentators have subscribed to Professor King's approach. See Perrochet, 27 Tort & Ins.L.J. at 624, 636-37 (listing eight states as adopting the Pure Lost Chance Theory); see also Martin J. McMahon, Annotation, Medical Malpractice: Measure and Elements of Damages in Actions Based on Loss of Chance, 81 A.L.R.4th 485 (1990). Compare Lori R. Ellis, Note, Loss of Chance as Technique: Toeing the Line at Fifty Percent, 72 Tex.L.Rev. 369 (1993). The argument in favor of the proportional approach is supported by the following reasoning. Since persons are ordinarily entitled to damages when they are harmed as a result of the negligence of another, it would seem unjust to deny compensation to a person simply because the harm suffered is a reduction in the person's chance of survival. If a patient's chance of surviving a disease is reduced from 49 percent to 0 percent because of a doctor's negligence in diagnosing and treating a disease, the patient has been deprived of a substantial opportunity to live. The argument in favor of the proportional approach which has persuaded a number of courts is that it is unjust not to remedy such a loss.