Court Opinion

ID: 9648422
Source: CourtListenerOpinion
Date Created: 2023-08-23 14:20:02.320641+00
Date Added: 2024-06-11T17:25:16.376466
License: Public Domain

NIGRO, Justice,
dissenting.
The majority today perpetuates an unfounded distinction in the law of informed consent between surgical and non-surgical procedures. Our lower courts have urged the Court to abolish this distinction and the legislature has enacted legislation superseding lower court precedent based upon it. Since there is no basis to require informed consent before surgery but not before other medical procedures, I would reverse the lower courts’ decisions and allow Appellants to pursue their claims.
The Court discussed the doctrine of informed consent in Gray v. Grunnagle, 423 Pa. 144, 223 A.2d 663 (1966). The Gray case produced a plurality opinion with a majority of the *209Court holding that whether a patient consented to surgery was a question for the jury. Even if the Court’s plurality opinion were binding precedent, it in no way limits the doctrine of informed consent to surgical procedures. While Gray involved an operation, the plurality reasoned that a doctor must obtain consent because otherwise he would commit a battery upon the patient. Since a battery is an intentional touching without consent, under Gray, other touchings should also require informed consent.
This principle was recognized in Cooper v. Roberts, 220 Pa.Super. 260, 286 A.2d 647 (1971), where the Superior Court evaluated a jury instruction addressing a doctor’s duty to disclose risks to a patient who underwent a gastroscopic examination. The court held that a doctor must disclose risks that a reasonable man would consider material to his decision to undergo treatment. While there was a dispute as to whether the examination was a surgical procedure, the court stated that the duty to disclose applied whether or not the treatment at issue was technically operative. Id. at 266-67 n. 2, 286 A.2d at 650 n. 2.
It appears that the notion that informed consent is not required for non-surgical procedures developed from the opinion of a Superior Court judge in Malloy v. Shanahan, 280 Pa.Super. 440, 421 A.2d 803 (1980). The court rejected a claim that informed consent was required when prescribing a therapeutic drug. In the opinion, the authoring judge quoted the trial court’s statement that “the doctrine of informed consent has been applied only to suits involving surgical operations____” Id. at 443, 421 A.2d at 804. The second judge on the panel concurred in the result and the third wrote a dissenting opinion maintaining that informed consent was required.
Presented again with the issue raised in Malloy, the Superi- or Court stated in Boyer v. Smith, 345 Pa.Super. 66, 72, 497 A.2d 646, 649 (1985), that informed consent “should continue to be limited” to cases involving surgery. Like Malloy, Boyer involved a patient who was allegedly not informed of the risks of oral medication. The court stated that to expand the *210application of informed consent to such a case would depart from the battery rationale espoused in Gray. Id.
In discussing Boyer, a district court found that the Boyer court went beyond the facts before it in stating that informed consent is only required for surgical procedures. Karibjanian v. Thomas Jefferson Univ. Hosp., 717 F.Supp. 1081, 1084 (E.D.Pa.1989). The Boyer court found that informed consent was not required when prescribing oral medication because there was no touching implicating a battery. Thus, the district court aptly stated that:
The middle ground over which the Boyer court leapt includes a case like the plaintiffs [in Karibjanian ] in which the patient is injected with a substance. A touching occurs, perhaps a painful one, yet it is something less than surgery.
Id. The district court concluded that it was reasonable to impose a duty of informed consent when a patient challenges the need for an injection. Id.
Nonetheless, as the majority recognizes, the Superior Court has repeatedly held that informed consent is only required for surgical procedures.1 The majority fails to mention that the Superior Court has also stated that it finds the surgical/ nonsurgical distinction without basis. See, e.g., Hoffman v. Brandywine Hosp., 443 Pa.Super. 245, 661 A.2d 397 (1995)(noting the artificiality of the distinction and one judge concurring solely to emphasize her discomfort with it); Stover v. Assoc. of Thoracic and Cardiovascular Surgeons, 431 Pa.Super. 11, 635 A.2d 1047 (1993)(noting the court’s trouble with the distinc*211tion); Wu v. Spence, 413 Pa.Super. 352, 605 A.2d 395 (1992)(stating that it may be time for this Court to reconsider the battery theory in Gray). I agree with our lower court that the surgical/non-surgical distinction is unfounded. Many non-surgical procedures involve a touching and may be technical batteries without informed consent just like surgery. Thus, under the current battery theory of informed consent, informed consent should be required for medical procedures beyond surgery. This is especially true today with technological advances that are invasive but no longer require a surgical cut.
The legislature’s recent amendments to the Healthcare Services Malpractice Act, 40 Pa. Stat. §§ 1301.101—1301.1006, support that the Court should abolish the distinction between surgical and non-surgical procedures. The amendments in part require informed consent before the administration of radiation or chemotherapy, blood transfusions, and experimental medication. Id. § 1301.811-A. This legislation supersedes Superior Court precedent that held that informed consent was not required for radiation or blood transfusions because they are non-surgical. See Hoffman v. Brandywine Hospital, 443 Pa.Super. 245, 661 A.2d 397 (1995)(informed consent not required for blood transfusion after surgery); Dible v. Vagley, 417 Pa.Super. 302, 612 A.2d 493 (1992), appeal denied, 535 Pa. 619, 629 A.2d 1380 (1993)(informed consent not required for radiation). Thus, the legislature has implicitly rejected a distinction between surgical and non-surgical procedures in imposing a statutory duty to provide informed consent.
Other states have imposed informed consent requirements based upon a negligence theory rather than a battery theory.2 These states have generally recognized that the failure to get informed consent is not a technical battery because the doctor’s omission is not due to a willful intent to injure the *212patient. See Malloy v. Shanahan, 280 Pa.Super. 440, 421 A.2d 803 (1980)(Hofftnan, J., dissenting and citing cases). In addition, the faulty conduct—the failure to inform—is not a touching. See id. Thus, other states have decided that a doctor’s duty to disclose the risks of medical treatment to the patient is an element of the duty of reasonable care. See id. This view comports with the concept underlying informed consent—that the patient has the right to determine what shall be done to his body. I agree that a negligence theory provides a stronger basis for the informed consent doctrine than a battery theory.
In sum, there is no basis to distinguish between surgical and non-surgical procedures in the law of informed consent. I would thus abolish this distinction and in addition, I would join other jurisdictions and adopt a negligence theory to support informed consent requirements.3

. The Supreme Court has addressed issues related to informed consent twice in cases involving surgeries and once in a case involving a nonsurgical procedure. In the surgery cases, Gouse v. Cassel, 532 Pa. 197, 615 A.2d 331 (1992) and Moure v. Raeuchle, 529 Pa. 394, 604 A.2d 1003 (1992), the Court did not consider the application of informed consent to non-surgical procedures. In the non-surgeiy case, Sinclair v. Block, 534 Pa. 563, 570-71, 633 A.2d 1137, 1140-41 (1993), the Court held that informed consent is not required to use forceps in delivering a baby. In rejecting the patient’s argument that the use of forceps involves a touching, the Court stated that informed consent presumes that the patient has a choice to make. Since labor is inevitable, the Court held that the informed consent doctrine does not apply to the natural delivery process. To the extent Sinclair also required a surgery for informed consent to apply, I disagree with the Court's decision.

. See, e.g., Gorab v. Zook, 943 P.2d 423 (Colo. 1997); Wecker v. Amend, 22 Kan.App.2d 498, 918 P.2d 658 (1996); Carr v. Strode, 79 Hawai'i 475, 904 P.2d 489 (1995); Faya v. Almaraz, 329 Md. 435, 620 A.2d 327 (1993); Arato v. Avedon, 5 Cal.4th 1172, 23 Cal.Rptr.2d 131, 858 P.2d 598 (1993); Jacobs v. Painter, 530 A.2d 231 (Me.1987); Wilkinson v. Vesey, 110 R.I. 606, 295 A.2d 676 (1972).

. I further disagree with the majority’s statement that a judicial expansion of the doctrine of informed consent today would be "effectively overtum[ed]” by the amendments to the Healthcare Services Malpractice Act. The legislature's decision to impose a statutory duty upon doctors to obtain informed consent before certain procedures does not preclude the Court from imposing a duty to disclose for other procedures under a negligence theory of liability.