Court Opinion

ID: 9772977
Source: CourtListenerOpinion
Date Created: 2023-08-29 17:34:15.641224+00
Date Added: 2024-06-11T07:31:49.546335
License: Public Domain

KILGARLIN, Justice,
concurring and dissenting.
I concur with that part of the majority opinion which would reverse the judgments of the courts below and remand Tom and Gloria Nelson’s cause of action to the trial court. However, I respectfully dissent from that portion of the majority opinion which declines to recognize Mark Nelson’s claim for medical expenses and special *932training which he may reasonably incur after age eighteen. The holding in Jacobs v. Theimer, 519 S.W.2d 846 (Tex.1975), would support Mark’s cause of action if damages were limited to “[t]he economic burden related solely to the physical defects of the child.” Id. at 849. The life versus nonlife question posed by the majority should not preclude Mark, after he attains majority, from recovering medical and other expenses which “lie within the methods of proof by which the courts are accustomed to determine awards in personal injury cases. No public policy obstacle should be interposed to that recovery.” Id.
In reality, the court’s decision denying Mark’s right to a negligence claim is contrary to fundamental policies and principles that have become the basis of tort law. Originally, forms of actions were rigidly prescribed, and the plaintiff had no cause of action unless he could fit his claim “into the form of some existing and recognized writ.” Prosser, Law of Torts § 4 at 19 (4th ed. 1971). Since that small beginning about 150 years ago, tort law has become a dynamic and flexible system of law designed to properly allocate losses that arise out of human activities.
“The entire history of tort law shows a continuous tendency to recognize as worthy of legal protection interests which previously were not protected at all.” Restatement (Second) of Torts § 1 comment e (1965). Although tort law's primary purpose is compensation for wronged plaintiffs, that has never been its only goal. Courts have always sought to reflect and adapt to changes in society acting to balance both individual and societal interests. Our courts have always recognized and used tort law’s unique ability to deter wrongdoing as a means of social policy. Restatement (Second) of Torts § 901 (1965). This concept has in fact become a part of Texas law. See McKisson v. Sales Affiliates, Inc., 416 S.W.2d 787 (Tex.1967) (recognition of strict products liability); Leal v. C. C. Pitts Sand & Gravel, Inc., 419 S.W.2d 820 (Tex.1967) (an unborn child can recover); Otis Engineering Corp. v. Clark, 668 S.W.2d 307 (Tex.1983) (employer held potentially liable for negligence of drunken off-duty employee).
Today we are confronted with the compelling responsibility of imposing legal accountability upon an aspect of medicine that is rapidly becoming a predominant social force. Genetic knowledge and expertise have increased as fast as any other medical specialty in the last ten years. Estimates now indicate that 12 million Americans suffer a type of genetic disease. See H.R.Rep. No. 498, 94th Cong., 1st Sess. 18-19 (1975) reprinted in [1976] U.S.Code Cong. & Ad.News 709, 726-27. Over 40% of all childhood diseases are caused partly by genetic factors. Day & Holmes, The Incident of Genetic Disease in a University Hospital Population, 25 AmJ.Human Genetics 237 (1973). Downs’ Syndrome alone costs society $1.7 billion dollars. House Report at 727. The ability to predict genetic disorders prior to birth has improved to the extent that at least 66 different genetic diseases are presently diagnosable prior to birth. Milunsky, Genetics and The Law, 54 (1976).
Despite the rapidly expanding impact of genetic knowledge upon our society, the law has failed to keep pace. Capron, Tort Liability in Genetic Counseling, 79 Co-lum.L.Rev. 618 (1979). Although today’s society is not the genetically controlled one anticipated in Aldous Huxley’s Brave New World, a doctor’s power to control genetic information, without restraint, may have subtle, far-reaching and devastating effects on family planning. Only by assuring a doctor’s legal accountability can we guard against an abuse of such power.
■ The decision to have children is fundamental to the very existence of a family. Mark Nelson as a practical matter could not make that decision for himself. The right to make that decision belongs to no one other than his parents. Yet that right is only meaningful if it is an informed decision. The right to an informed decision with regard to future offspring emphasizes the need for legal safeguards in this area. The majority opinion, by refusing to impose *933more than limited responsibility for negligent genetic counseling, fails to keep the law abreast of burgeoning knowledge and does not provide needed legal accountability. The court's inaction today merely postpones the necessity of acting in a medical area that will increasingly dominate our society. Moreover, the court entirely overlooks the real victim of the malpractice, Mark Nelson. Because the court allows recovery only when a child’s parents are both willing and capable of bringing a timely suit, a child potentially will receive no redress at all. In Sax v. Votteler, 648 S.W.2d 661 (Tex.1983), although we allowed Lori Beth Sax a claim in her own right, the parents, by waiting too long to bring suit, were denied recovery. Similarly, had the Nelsons waited more than two years after discovering Mark’s condition, Mark’s defects would go uncompensated, for he, unlike Lori Beth Sax, is denied a cause of action. This is exactly what would have happened had the court in Procanik v. Cillo, 97 N.J. 339, 478 A.2d 755 (1984), not allowed the minor a wrongful life claim. There, Peter Procanik’s parents allowed limitations to run on their wrongful birth cause, and thus were denied recovery in their individual capacities.
No difficulty is created by permitting Mark to allege common law negligence. In a genetic malpractice or wrongful life action, the genetically impaired child alleges that the negligence of the physician or other genetic counselor, by failing to inform his parents of the risk of giving birth to an impaired child, caused his birth. Comment, “Wrongful Life”: The Right Not To Be Born, 54 Tul.L.Rev. 480, 485 (1980); Harbeson v. Parke-Davis, 656 P.2d 483, 494 (Wash.1983). The cause may be determined by using the traditional negligence elements of duty, breach of duty, proximate cause and damages. Turpin v. Sorting 31 Cal.3d 220, 643 P.2d 954, 965, 182 Cal.Rptr. 337, 348 (1982). Thus, this action is merely a form of medical malpractice. Turpin, 182 Cal.Rptr. at 342, 643 P.2d at 959; Harbeson, 656 P.2d at 495.
Mark alleges Dr. Krusen had a duty to provide the Nelsons with accurate information to enable them to make an informed decision of whether to give birth to Mark and that this duty flowed directly to him. I agree. But more importantly, neither Dr. Krusen nor the hospital deny that this duty was owed. This duty is within the Texas rule that a physician must properly inform a patient. See Roark v. Allen, 633 S.W.2d 804 (Tex.1982); Wilson v. Scott, 412 S.W.2d 299 (Tex.1967). It was foreseeable that Mark’s parents would rely upon the information provided by Dr. Krusen in deciding whether it would be in Mark’s best interest to be born with Duchenne muscular dystrophy since Mark was unable to make this decision. Their right to make such a decision is currently the law. Jacobs, 519 S.W.2d at 848. The failure to provide the Nelsons with correct information was a breach of duty owed directly to Mark. See, e.g., Turpin, 182 Cal.Rptr. at 339, 643 P.2d at 956; Harbeson, 656 P.2d at 496. The judgment of a parent or guardian may be substituted for that of the child when the child is incompetent and unable to decide whether he prefers nonlife to an impaired existence. In the Matter of Quinlan, 70 N.J. 10, 355 A.2d 647 (1976); Superintendent of Belchertown State School v. Saikewicz, 373 Mass. 728, 370 N.E.2d 417 (1977).
However, merely because a child is born in an impaired condition does not mean that the physician has breached this duty. His conduct must be measured against the degree of skill, care and knowledge possessed and exercised by others engaged in genetic counseling. The child must show by affirmative proof that the defendant did not meet this standard.
In a genetic malpractice action, the child must prove not that the defendant’s negligence caused his injuries but that it caused his birth. The child, like his parents in a wrongful birth action, must show that but for the defendant’s negligence in adequately detecting and/or informing his parents of his condition or of the risk, he would never have been born. Note, Wrongful Life: Should The Cause Of Action Be Recognized, 70 Ky.L.J. 163, 177-78 (1982); *934Comment, “Wrongful Life”: The Right Not To Be Born, supra, at 485. The child, like his parents, must prove that had his parents been provided with accurate information relating to the risk, they would have prevented his birth. In this case there is no difficulty in showing causation. The Nelsons consulted Dr. Krusen, after Mark’s conception, for the specific purpose of determining whether Mrs. Nelson was a carrier of the disease. After being informed that she was no more likely to have another child afflicted with muscular dystrophy than any other female, the pregnancy was permitted to continue and Mark was born with muscular dystrophy.
The majority opinion does not deny that Dr. Krusen owed a duty to Mark through his parents. Nor does the majority object to Mark’s ability to prove either breach of that duty or proximate cause. Instead, the majority argues that as a matter of law, Mark is unable to prove injury, because in weighing life against nonlife, “it is impossible to rationally decide whether the plaintiff has been damaged at all.”
Nonetheless, in reaching the decision that Mark can never prove injury, the majority has impliedly held that in a court of law, life, however defective, is preferable to nonexistence, a thing the majority contends is incapable of measurement. To reach this value decision, the court has relied upon case law resting on the “high value which the law and mankind has placed on human life, rather than its absence. Becker v. Schwartz, 413 N.Y.S.2d 895, 386 N.E.2d at 812.”
Our decision in Jacobs v. Theimer and the decision today allow parents to recover for the “wrongful birth” of their child. By necessity this claim also requires a choice between competing values. A jury considers the intangible benefits of having a child, regardless of the child’s defects, a measure of life versus nonlife. It is difficult to understand why the court allows recovery for the parents but not the child— why life versus nonlife is capable of measurement in one instance but not the other.
The absurdity of distinguishing between the two claims also is demonstrated by the practical effect of awarding damages to the parents. Since the child will be the real, if not formal, beneficiary of the parents’ recovery for health care and other expenses, any remaining difficulty in allowing claims directly on behalf of an affected child seems shortsighted, especially if it is based on metaphysical refinements. See Capron, supra, at 639. Limiting recovery to the parents creates additional conceptual and legal problems. Because expenses in such cases were proximately caused by the doctor's negligence, denial of Mark's claim improperly allocates costs. Since the child is permitted no claim, unlike other suits brought by parents on behalf of their children, the child is not protected by a trust. Nor is the recovery placed in the registry of the court. Because some parents will be either unable or unwilling to support their child after adulthood, the child should have an “independent recovery to cover his extra costs of living with a genetic defect.” Comment, A Preference for Non-Existence: Wrongful Life to a Proposed Tort of Genetic Malpractice, 55 S.Cal.L.Rev. 477, 500 (1982). If a child is left without parents, the costs for support will be borne by someone else, often the state. Denial of a wrongful life claim could allow a doctor to be a wrongdoer without requiring him to compensate the person wronged most. As such, the court’s action not only undermines a primary purpose of tort law, but it also weakens another policy, the deterrent function of imposing liability. Prosser, supra, § 4 at 23. See also Calabresi, The Costs of Accidents 73-75 (1970).
Finally, it must be noted that other courts have awarded special damages to children in Mark’s condition. See Turpin v. Sortini, 182 Cal.Rptr. at 337, 643 P.2d at 954; Harbeson v. Parke-Davis, Inc., 656 P.2d at 483. In awarding special damages, courts recognizing a suit based upon genetic malpractice have not found it necessary to resolve questions comparing life to non-life. Procanik v. Cillo; Woodruf v. Hoffman, Conn.Supp. (1983).
*935In conclusion, recognition of Mark’s claim would be consistent with the social objectives of preventing malpractice in genetic and prenatal counseling and act as a deterrent to. negligent conduct. Harbeson, 656 P.2d at 496; Turpin, 182 Cal.Rptr. at 348, n. 15, 643 P.2d at 965, n. 15. Such a decision would place nonlife/life decisions in the proper hands, those of Mark’s parents. Because genetic malpractice or wrongful life is a cognizable cause of action under Texas common law, the judgment of the court of appeals should in all things be reversed.