Opinion ID: 2607347
Heading Depth: 3
Heading Rank: 1

Heading: Dr. Char Misreads Leyson and Misinterprets the Modified Objective Standard

Text: In Leyson, the ICA set out the elements of the tort of a physician's failure to disclose risks of harm prior to treatment as follows: (1) [the physician] owed a duty to disclose to [the patient] the risk of one or more of the collateral injuries that [the patient] suffered; (2) [the physician] breached [his or her] duty; (3) [the patient] suffered injury; and (4) [the physician's] breach of duty was a cause of [the patient's] injury in that: (a) [the physician's] treatment was a substantial factor in bringing about [the patient's] injury and (b) [the patient], acting rationally and reasonably, would not have undergone the treatment had he [or she] been informed of the risk of the harm that in fact occurred; and (5) no other cause is a superseding cause. 5 Haw.App. at 516-17, 705 P.2d at 47 (emphases added). Discussing element 4(b) [hereinafter, part (b) causation], the Leyson court noted that: There is disagreement whether this question should be examined from the viewpoint of Leyson, a reasonable person in Leyson's position, an ordinary person in Leyson's position, or some other viewpoint. We agree that [e]very human being of adult years and sound mind has a right to determine what shall be done with his [or her] own body. Schloendorff v. Society of New York Hospital, 211 N.Y. 125, 129, 105 N.E. 92, 93 (1914). Moreover, we recognize that what a reasonable and competent physician thinks his patient should be told is not necessarily what the patient would find significant in making his [or her] decision. Since it never happened, however, it is impossible to determine what Leyson would have done had he been properly informed. Moreover, the reasonableness factor would weigh heavily, if not predominantly, in the determination of the credibility and weight of the evidence on the subject. Consequently, we opt for the application of a modified objective standard that determines the question from the viewpoint of the actual patient acting rationally and reasonably. Id. at 517 n. 10, 705 P.2d at 47 n. 10 (some citations omitted and emphasis added). Referencing the highlighted language above, Dr. Char maintains that Bernard failed to establish part (b) causation. Dr. Char argues that it was not impossible to determine what Bernard would have done had he been properly informed because Bernard was available to testify about what he subjectively would have done. By not testifying as to what he would have done, Dr. Char argues that Bernard failed to carry his burden, and the jury is forced to substitute their judgment for the judgment of the patient. We disagree with Dr. Char's reading of Leyson. We believe it is clear from the above-quoted passage from Leyson that the impossibility surrounding the task of determining what the patient would have done had he or she been properly informed stems not from the patient's reluctance or inability to testify, or from the patient's counsel's failure to elicit testimony from the patient regarding what the patient subjectively would have done had the patient been properly informed; rather, the impossibility stems from the fact that the proper disclosure was not made. The passage from Leyson, therefore, merely comments on one of the lamentable, yet inescapable, characteristics of the inquiry surrounding resolution of the causation issue in a case involving a claim for relief founded on the doctrine of informed consent, that is, that the part (b) causation inquiry rests on pure conjecture. The passage does not implicitly set out a requirement that, in order to sufficiently establish causation in an informed consent case, the plaintiff-patient must actually testify as to what the plaintiff-patient subjectively would have done had the proper disclosure been made. Moreover, we believe it would be unusual for a plaintiff not to claim that, had he or she been properly informed, he or she would have declined treatment. As one commentator has noted: In virtually every such case, plaintiff-patient will testify that, given adequate disclosure, he [or she] would not have consented, and the plaintiff's right to recover and the defendant physician's vulnerability to liability should not be made dependent on that self-serving testimony of the plaintiff. How persuasive is that explanation? It should be conceded immediately that indeed plaintiff will testify that, adequately informed, he [or she] would not have consented. To do otherwise, would require the granting of defendant's motion for non-suit or directed verdict and would make one wonder why plaintiff and his lawyer had invested all of the time, effort and money necessary for the preparation for and the participation in the trial. Seidelson, Medical Malpractice: Informed Consent Cases in Full-Disclosure Jurisdictions, 14 Duquesne L.Rev. 309, 330 (1976) [hereinafter Seidelson]; see also Cobbs v. Grant, 8 Cal.3d 229, 245, 104 Cal.Rptr. 505, 515-16, 502 P.2d 1, 11 (1972) (Since at the time of trial the uncommunicated hazard has materialized, it would be surprising if the patient-plaintiff did not claim that had he [or she] been informed of the dangers he [or she] would have declined treatment. Subjectively, he [or she] may believe so, with the 20/20 vision of hindsight, but we doubt that justice will be served by placing the physician in jeopardy of the patient's bitterness and disillusionment.).