Court Opinion

ID: 9724019
Source: CourtListenerOpinion
Date Created: 2023-08-26 10:41:45.065985+00
Date Added: 2024-06-11T18:24:54.445565
License: Public Domain

JOHNSON, J.—I respectfully dissent.
Contrary to the majority I conclude the California Supreme Court already resolved the sole issue involved in this case almost 10 years ago. In Turpin v Sortini (1982) 31 Cal.3d 220 [182 Cal.Rptr. 337, 643 P.2d 954] our high court established the general rule that tortfeasors in general, including negligent automobile operators, owe a duty to postconceived children for damages these infants later sustain as a result of injuries the tortfeasor inflicted on their mothers. Furthermore, assuming it were an issue of first impression, I conclude the existence of this duty is supported by fundamental principles governing tort law in California. Accordingly, I would reverse the demurrer in this case.
*1136I. The California Supreme Court Already Has Extended the Duty of Care to Children Conceived After the Tortious Act Is Committed Against Their Mothers
Although the court below treated this as a case of first impression in California, the central legal question—whether a tortfeasor can be held liable for injuries experienced by a child conceived after the tortious act—most certainly is not an issue of first impression in this state. Indeed, the California Supreme Court has spoken directly on the point and allied our state with those jurisdictions allowing postconceived children a remedy against those who injure their mothers in such a way they emerge from the womb severely impaired or worse.
In the very same opinion where our high court decided a child could not recover general damages for her “wrongful birth,” it also held:
“With respect to the issue of legally cognizable injury, ... the difficult question here does not stem from the fact that defendants’ allegedly negligent act and plaintiff’s asserted injury occurred before plaintiff’s birth. Although at one time the common law denied recovery for injuries inflicted before birth, California—in tune with other American jurisdictions—has long abandoned that arbitrary limitation. [Citations omitted.] Thus, if [the plaintiff infant’s] deafness . . . resulted from a tort committed upon her mother before conception (see, e.g., Renslow v. Mennonite Hospital (1977) 67 I11.2d 348 [367 N.E.2d 348, 91 A.L.R.3d 291]); Bergstresser v. Mitchell (8th Cir.1978) 577 F.2d 22; Annot. (1979) 91 A.L.R.3d 316), it is clear that she would be entitled to recover against the negligent party.” (Turpin v. Sortini, supra, 3 Cal.3d 220, 230-231, italics added.)
This statement of law is not dictum. Indeed it is “essential to the court’s reasoning” and to the result in the Turpin opinion. For, if the court had ruled otherwise on this issue, that would have ended the matter. The infant plaintiff in that case indeed had been conceived after the defendant’s negligent acts. Thus, if a child would not be entitled to recover against a negligent party for torts committed against her mother before conception, the Turpin plaintiff would have been out of court on that ground—and would have been out of court, entirely, not merely for purposes of general damages.
Having ruled as it did on the issue relevant in the instant case, the California Supreme Court had to reach a further question in Turpin. There the defendant’s alleged negligence was a failure to warn the parents of a hereditary condition which meant their child, the plaintiff, if conceived was destined to be born deaf. Criticizing an appellate court opinion (Curlender v. *1137Bio-Science Laboratories (1980) 106 Cal.App.3d 811 [165 Cal.Rptr. 477]) which had upheld the child’s right to general damages in such a case, the court highlighted the vital difference between Turpin and situations, like the instant case, where a tortfeasor—not genetics—has injured the mother.
“The basic fallacy of the Curlender analysis is that it ignores the essential nature of the defendants’ alleged wrong and obscures a critical difference between wrongful life actions and the ordinary prenatal injury cases noted above. In an ordinary prenatal injury case, if the defendant had not been negligent, the child would have been born healthy; thus, as in a typical personal injury case [like the instant case], the defendant in such a case [like the instant case] has interfered with the child’s basic right to be free from physical injury caused by the negligence of others. In this case, by contrast, the obvious tragic fact is that plaintiff never had a chance ‘to be born as a whole, functional human being without total deafness’; if defendants had performed their jobs properly, she would not have been bom with hearing intact, but—according to the complaint—would not have been born at all.” (Turpin v. Sortini, supra, 31 Cal.3d at p. 231.)
Although respondents at times attempt to characterize the instant case as a “wrongful birth” case—and persuaded the trial court and the majority of this court to treat it as one—it is apparent from the Turpin analysis it clearly is not. But for defendants’ negligence injuring plaintiff’s mother, the Heyges’ infant would have been “born as a whole, functional human being.” Unlike Turpin, it is by no means true that if defendant had “performed [his driving] properly, she . . . would not have been born at all.” Accepting the allegations of the complaint, she just would have been bom healthy instead of terribly impaired. So we need not face any of the metaphysical paradoxes —is it better to live with a handicap than not to have lived at all—that trouble the courts in “wrongful life” cases. Nor need we bother with the damage calculation (and cancellation) problems—mitigating pain and suffering damages with the value of existence—which persuaded the Supreme Court to deny recovery of general damages in such cases.
In evaluating the precedential value of the quoted language in Turpin, it also is important to recall the ultimate result in that case. Having found a duty to postconceived children and a violation of that duty, but concluding it was unwilling and unable to award general damages, the Supreme Court nevertheless approved the awarding of special damages to postconceived children even in these “wrongful birth” cases. Consequently, the court’s holding there is a duty to postconceived children was essential to the result in that case. Far from dictum, it is a full-fledged holding of this state’s highest court and binding on lower courts.
*1138As a second line of defense, respondents urge the duty to postconceived children is only owed by medical practitioners and products manufacturers and not by other tortfeasors. They construct this supposed limitation out of the happenstance that most of the handful of cases discussing this duty thus far have been medical malpractice and/or product liability cases. However, the rule announced in Turpin and the line of cases on which the California Supreme Court relied in Turpin is not in any way limited to the medical malpractice or drug manufacturer context.
In Turpin itself, as will be recalled, the California Supreme Court stated the rule in the most comprehensive terms, imposing liability for any “tort committed upon [an infant’s] mother before conception.” If the court meant to limit the duty to the kind of tortfeasor which happened to be involved in that case, it could have imposed liability for any “malpractice committed upon the mother before conception.” But instead it used a general term in order to state a general principle. Thus, under Turpin the class of defendants who have a duty toward postconceived children includes all “tortfeasors”— not just medical malpractice tortfeasors, not just product liability tortfeasors, but tortfeasors in general.
The California Supreme Court in Turpin cited two out-of-state cases supporting the tortfeasor’s duty to postconceived children. The first of these is Renslow v. Mennonite Hospital, supra, 67 I11.2d 348 [367 N.E.2d 1250]. In that case doctors transfused Rh-positive blood into the veins of an Rh-negative girl when she was 13 years old. The girl grew up, married, and became pregnant. During the prenatal period her obstetrician discovered the improper transfusion eight years earlier had affected the mother’s body chemistry in such a way as to cause damage to the fetus. As in the instant case, this necessitated a premature delivery and resulted in serious, permanent disabilities.
As the California Supreme Court did in Turpin, the Illinois Supreme Court expressed its holding in the broadest terms, not limited to medical malpractice situations, and supported the new rule with a rationale which applies with equal force to the instant case. “This court has long recognized that a duty may exist to one foreseeably harmed though he be unknown and remote in time and place [Citations omitted], . . .The cases allowing relief to an infant for injuries incurred in its previable state make it clear that a defendant may be held liable to a person whose existence was not apparent at the time of his act. We therefore find it illogical to bar relief for an act done prior to conception where the defendant would be liable for this same conduct had the child, unbeknownst to him, been conceived prior to his act. We believe there is a right to be bom free from prenatal injuries foreseeably caused by *1139a breach of duty to the child’s mother.” (Renslow v. Mennonite Hospital, supra, 367 N.E.2d 1250, 1254-1255, italics added.)
Rather than limit the duty to medical practitioners, the Illinois Supreme Court instead implied it was excluding certain limited categories of defendants from the duty—those whose nuclear or chemical accidents do genetic damage that passes down through the generations, thus creating “self-perpetuating” injuries afflicting “remote descendents.” (367 N.E.2d at p. 1255.) Nowhere is it hinted the court intended to exclude a driver who harms a specific woman in such a way as to injure a specific child who is conceived after the negligent event.
Indeed the rationale used to justify extending recovery to these post-conceived children clearly applies to the offspring of women injured in automobile accidents. That express rationale was that postconceived children should be treated the same as already conceived fetuses whose existence was unknown to the tortfeasor. (367 N.E.2d at p. 1255, quoted above.) Respondents clearly would owe a duty to an unknown fetus who was injured in her mother’s womb during this same automobile accident under California law (Scott v. McPheeters (1939) 33 Cal.App.2d 629 [92 P.2d 678]) as well as under Illinois law (Amann v. Faidy (1953) 415 I11. 422 [114 N.E.2d 412] [pregnant mother injured in automobile accident gave birth to impaired infant who died shortly after birth and wrongful death action allowed]; Rodriquez v. First Nat. Bank (1953) 415 I11. 496 [114 N.E.2d 721] [infant entitled to recover for personal injuries resulting from negligent acts committed on mother while plaintiff was fetus].) Consequently, applying the rationale of the Renslow opinion cited with approval by the California Supreme Court in Turpin, respondents owed a duty to the unknown postconceived infant in the instant case.
The other out-of-state case on which the California Supreme Court relied in announcing its rule in Turpin was Bergstreser v. Mitchell (8th Cir. 1978) 577 F.2d 22. This, too, was a case arising out of medical malpractice. Yet once again the holding the court announced and the rationale it used to justify that holding were much broader and would clearly support a duty of negligent car drivers toward the postconceived children of their female victims.
In Bergstresser the malpractice happened two years before the plaintiff’s birth when the doctor damaged the mother’s uterus in the course of a Caesarean delivery of an earlier child. As in the instant case, this eventually required the plaintiff to be delivered prematurely. During that delivery the infant suffered serious injuries including brain damage.
*1140The Eighth Circuit was called upon to decide whether Missouri law would allow recovery for “injuries arising from allegedly negligent acts occurring prior to his conception.” The court adopted a line of reasoning similar to the Illinois Supreme Court in Renslow. “[T]he case law on prenatal injuries is the best available means of predicting the rule which the Missouri courts would apply to claims for preconception injuries. This case law shows that, . . . the Missouri Supreme Court has chosen to recognize a cause of action, has refused to be bound by outmoded common law and has declined to allow an injury to be suffered without a remedy. After considering this case law, we agree with the District Court that the courts of Missouri would permit an infant, born alive, to bring an action for injuries arising out of preconception negligent conduct.” (Bergstreser v. Mitchell, supra, 577 F.2d 22, 25, italics added.)
So once again an opinion on which the California Supreme Court relied in Turpin announces a rule which speaks of “preconception negligent conduct” in broad terms, not “preconception malpractice” or “preconception conduct of the type involved in this case.” And, once again, the opinion reasons the same rule should apply in the same situations for preconception injuries as for prenatal injuries.
The logic of these opinions is inescapable and applies directly to the instant case. These courts emphasize it is difficult to conjure any independent policy reasons for granting recovery to the existing fetus but denying it to the postconceived fetus. Consequently, foreseeability is the touchstone in deciding whether a duty exists. If it is foreseeable a woman injured in a traffic accident will be carrying an embryo or fetus, perhaps unknown even to her at the time, who might be injured subsequently because of damage done to the mother’s reproductive capacity in that accident, it also is foreseeable that a woman, similarly damaged in her reproductive capacity, will later conceive a fetus who will suffer like injuries. Under California law, a duty exists toward fetuses in ordinary negligence situations—such as automobile collisions. (Scott v. McPheeters, supra, 33 Cal.App.2d 629.) Consequently, a duty exists in those same situations toward later-conceived children. The California Supreme Court recognized the wisdom of that reasoning in Renslow and Bergstreser and announced it as a rule in Turpin.
It is noteworthy the California Supreme Court cited Renslow and Bergstreser with approval, and not the contrary authority which existed at the time Turpin was decided, Albala v. City of New York (1981) 54 N.Y.2d 269 [445 N.Y.S.2d 108, 429 N.E.2d 786], an opinion upon which respondents *1141and the majority opinion rely so heavily.1 Significantly, Albala likewise arose in a medical malpractice context. Thus, it lends no support for a distinction based on whether the tortfeasor is a medical practitioner rather than an automobile owner or driver.
Instead, the majority in the Albala decision simply took the opposite position from Illinois, California and the Eighth Circuit and held tortfeasors in general owe no duty to postconceived children. The majority conceded it was “foreseeable that [the mother] would again conceive and that the health of children born thereafter could be adversely affected by damage to her uterus.” But it alluded to vague but sensitive “policy issues” which militated against imposing a duty on tortfeasors toward postconceived children. These policy issues boiled down to only two: first, the typical “the sky is falling” argument traditionally leveled against any and all expansions of tort liability and, second, concerns about “the undesirable impact of encouraging the practice of ‘defensive medicine’.” (429 N.E.2d at p. 788.) It probably was the lack of substance in the New York court’s policy analysis which led Prosser and Keeton to characterize Albala as a “thinly reasoned case.” (Prosser & Keeton, The Law of Torts (5th ed. 1984) § 55, p. 369, fn. 27.)
In any event, the “sky is falling” argument carried little weight with the Renslow and Bergstreser courts, and presumably not with the California Supreme Court when it chose to rely on these cases and not Albala in Turpin. As to the “defensive medicine” concern, that issue is not presented at all in the instant case since it involves negligent driving and not negligent medical treatment. There may be reason to be worried about the economic costs of too much “defensive medicine.” But I seriously doubt many would be unhappy if imposing a duty toward postconceived children somehow led to *1142an increase in “defensive driving” on our crowded, dangerous streets and freeways.2
Based on my analysis of the California Supreme Court decision in Turpin v. Sortini, and the cases on which it relies, I conclude our high court placed California squarely among the jurisdictions which impose a duty on tortfeasors toward postconceived children.3 Furthermore, I find nothing in Turpin or the out-of-state cases it cited with approval suggesting this duty is imposed solely on medical practitioners or manufacturers of drugs and similar products. Thus, I determine the duty applies to tortfeasors in general and already has been extended to postconceived children. Thus, the trial court erred when it ruled it would be an “unwarranted extension of liability.” Not only is it not unwarranted it has already happened. Consequently, the trial court’s finding the respondents owed no duty to appellant and the demurrer based on that finding should be reversed under principles of stare decisis. (Auto Equity Sales v. Superior Court (1962) 57 Cal.2d 450.)
*1143II. If This Were an Issue of First Impression, Under the Criteria Announced in Rowland v. Christian Tortfeasors Like Respondent Owe a Duty of Care to Children Conceived After the Tortious Act Is Committed Against Their Mothers
As discussed above, the California Supreme Court already has considered the duty question which is the only issue on appeal in this case. Under principles of stare decisis I conclude this appellate court is bound by the higher court’s resolution of that question. Nonetheless, as an independent and sufficient grounds for my opinion in this case and in further support of the Supreme Court’s holding on this issue, I have applied general principles of California tort law and determined it is appropriate to impose a duty on tortfeasors like respondent toward postconceived children.
A. The Proper Analysis of the Facts of This Case Is Under Rowland v. Christian
On the issue of duty, California has “repeatedly eschewed overly rigid common law formulations ... in favor of allowing compensation for foreseeable injuries caused by a defendant’s want of ordinary care.” (J’Aire Corp. v. Gregory (1979) 24 Cal.3d 799, 805 [157 Cal.Rptr. 407, 598 P.2d 60].) Thus in Rowland v. Christian (1968) 69 Cal.2d 108 [70 Cal.Rptr. 97, 443 P.2d 561, 32 A.L.R.3d 496] the California Supreme Court adopted, as a general principle, the concept contained in section 1714 of the California Civil Code which reads in part: “Every one is responsible ... for an injury occasioned to another by his want of ordinary care or skill in the management of his property or person.” While the facts of the Rowland case concerned the liability of the possessor of property to a licensee, the rule enunciated in Rowland has been applied in diverse factual contexts. (See, e.g., J’Aire Corp. v. Gregory, supra, 24 Cal.3d 799 [contractor owes a duty of care to tenant of building undergoing construction work to prevent foreseeable economic injury to tenant’s business]; Tarasoff v. Regents of University of California (1976) 17 Cal.3d 425 [131 Cal.Rptr. 14, 551 P.2d 334, 83 A.L.R.3d 1166] [therapist owes a duty of care to third persons who may foreseeably be harmed by patient]; George A. Hormel & Co. v. Maez (1979) 92 Cal.App.3d 963 [155 Cal.Rptr. 337] [automobile driver owes a duty of care to factory for economic damages due to electrical outage caused by vehicle striking a power pole]; Curlender v. Bio-Science Laboratories, supra, (1980) 106 Cal.App.3d 811 [medical laboratory owes a duty of care to child born after the laboratory failed to warn the child’s parents of the likelihood of child being born with genetic disorder].)
The court in Rowland made clear their intention that this rule be broadly applied by declaring: “[although it is true that some exceptions have been *1144made to the general principle that a person is liable for injuries caused by his failure to exercise reasonable care in the circumstances, . . . in the absence of [contrary] statutory provision [s] ... no such exception should be made unless clearly supported by public policy.” (Rowland v. Christian, supra, 69 Cal.2d at p. 112.) Hence, under California law there is a presumption that all citizens owe a duty to exercise reasonable care in their actions which, in the circumstances, might pose the danger of injury to the person or property of others. This presumption may be overcome only if clearly mandated by considerations of public policy or by statute.4
*1145To aid in the determination of when public policy might demand a departure from this principle, the Rowland court set out a number of factors to be balanced. These factors are: the foreseeability of harm to the plaintiff, the degree of certainty that the plaintiff suffered injury, the closeness of the connection between the defendant’s conduct and the injury suffered, the moral blame attached to the defendant’s conduct, the policy of preventing future harm, the extent of the burden to the defendant and consequences to the community of imposing a duty to exercise care, and the availability, cost and prevalence of insurance for the risk involved. (Id. at pp. 112-113.)
While this list of factors is appropriate for the majority of negligence suits it is not, nor was it intended to be, exhaustive for all cases involving alleged negligence. Thus, in Borer v. American Airlines, Inc. (1977) 19 Cal.3d 441 [138 Cal.Rptr. 302, 563 P.2d 858], the court declined to recognize a cause of action for loss of parental consortium, citing reasons of social policy. The Borer court was concerned with the possibility of an uncontrolled expansion of liability, pointing to the intangible nature of the loss in such an action, the difficulty of measuring damages for such a loss, and the fact no American jurisdiction then permitted a child to sue for loss of parental consortium. The court justified adding these considerations to the liability analysis because unlike Rowland, the Borer case involved the creation of a new cause of action for solely intangible damages.
In Thing v. La Chusa (1989) 48 Cal.3d 644 [257 Cal.Rptr. 865, 771 P.2d 814], the California Supreme Court again found the Rowland factors inconclusive in determining liability, this time in an action for negligent infliction of emotional distress (NIED). As in Borer, the court noted injuries in such a case are intangible, and “[Recovery for this type of damage, when no other injury is present, has never been subject only to the general principles of foreseeability applied in Rowland v. Christian.” (Thing v. La Chusa, supra, 48 Cal.3d 644, 668, fn. 10, italics added.) However, notwithstanding the fact *1146that other considerations are present in an action for NIED, such a cause of action has been recognized in California since 1968. (See Dillon v. Legg (1968) 68 Cal.2d 728 [69 Cal.Rptr. 72, 441 P.2d 912, 29 A.L.R.3d 1316].) Importantly, the Thing court’s recognition that other policy considerations were necessary to restrict the possibility of unlimited liability in NIED actions led the court to restrict and enumerate the class of plaintiffs who could bring such an action as a matter of law. (Thing v. La Chusa, supra, 48 Cal.3d at p. 668, fn. 10.)
By contrast, the present case involves none of the dangers of expanded liability which were present in Borer or Thing, and thus a judicial restriction of the plaintiff class such as is seen in the latter case is both unnecessary and inappropriate. Despite its initial appearance, this case is nothing more or less than a personal injury suit—Cassondra Hegyes alleges a tangible injury caused by the respondents’ negligence. This is not a wrongful life case, in which the alleged injury is that, but for the defendant’s negligence, the plaintiff would not have been bom at all.5 Nor is this really a prenatal injury case, since Cassondra’s respiratory condition did not exist in útero but only became manifest after her premature birth. Analytically however, this case is similar to the prenatal injury cases, where “as in a typical personal injury case, the defendant... has interfered with the child’s basic right to be free from physical injury caused by the negligence of others.” (Turpin v. Sortini, supra, 31 Cal.3d 220, 231, italics added.)
Since the facts of the present case are essentially those of a typical personal injury suit, it does not require the recognition of a new cause of action for us to assess the sufficiency of the appellant’s complaint. Nor should the fact that Cassondra was not conceived at the time the tort was committed distract us from the observation that there is little danger of an endless expansion of liability in such a case—the alleged injury is not one with potential multigenerational effects, such as are found in the DES cases and ones involving radiation exposure. Because the injury alleged is a tangible one, the calculation of damages is no more difficult than in any other personal injury case. Thus, none of the policy reasons cited in Borer or Thing which necessitated the consideration of factors additional to those mentioned in Rowland v. Christian exist in this case, and I need not use them in the analysis.
*1147B. Application of the Rowland Factors to the Facts of the Present Case 1. Foreseeability of Harm to Cassondra Hegyes
The California Supreme Court has stated that foreseeability of the risk is a primary consideration in establishing the element of duty. (Weirum v. RKO General, Inc. (1975) 15 Cal.3d 40, 46 [123 Cal.Rptr. 468, 539 P.2d 36].) However, foreseeability is not only a consideration in the court’s willingness to find the existence of a duty, but is also to be assessed by the trier of fact in the determination whether the specific injury in issue was foreseeable. (Thing v. La Chusa, supra, 48 Cal.3d at p. 654, fn. 3.) Thus, “a court’s task—in determining duty—is not to decide whether a particular plaintiff’s injury was reasonably foreseeable in light of a particular defendant’s conduct, but rather to evaluate more generally whether the category of negligent conduct at issue is sufficiently likely to result in the kind of harm experienced.” (Ballard v. Uribe (1986) 41 Cal.3d 564, 572-573, fn. 6[,] italics in original.) It is the province of the jury, by contrast, to conduct a fact-based inquiry into whether the particular defendant’s conduct was negligent at all, and, if so, whether it was a proximate cause of the plaintiff’s injury. (Ibid., see also 6 Witkin, Summary of Cal. Law (9th ed. 1988) Torts, § 967 pp. 356-3S7.)6 This is borne out by the California Supreme Court’s opinion in Weirum v. RKO General, Inc., supra, 15 Cal.3d 40 [123 Cal.Rptr. 468, 539 P.2d 36]. The court affirmed a lower court’s ruling that a radio station was liable for the wrongful death of a motorist forced off the road by youthful listeners participating in a promotional contest. Although the radio station was not particularly aware of the decedent’s existence, as a user of the public streets and highways the decedent was nevertheless of a class of persons to which an unreasonable risk of harm was foreseeably created by the nature of the radio broadcast. Moreover, the court held, “‘[t]he mere fact that a particular kind of an accident has not happened before does not. . . show that such accident is one which might not reasonably have been anticipated.’” (Id. at p. 47, citing Ridley v. Grifall Trucking Co. (1955) 136 Cal.App.2d 682, 686 [289 P.2d 31].)
Hence, in Weirum the court upheld the jury’s finding that it was reasonably foreseeable to the radio station that a driver might be injured or killed as a proximate result of the station’s contest format. In so doing, the court implicitly affirmed the trial court’s finding that the risk created by a radio station’s negligent broadcast was sufficiently likely to result in injuries due to an automobile accident as to place a duty of care on such radio stations towards the general public. The findings of the jury based on the evidence *1148presented at trial that the plaintiff’s injuries were foreseeable in light of the particular broadcast at issue was a matter of fact, and not the province of the court. (Weirum v. RKO General, Inc., supra, 15 Cal.3d 40, 46.)
Applying these principles to our analysis of the present case, we must ask whether negligent operation of a motor vehicle is sufficiently likely to cause injury to an infant resulting from its premature birth. An affirmative answer to this question weighs against overcoming the presumption of the existence of duty set out in Rowland v. Christian.
This is the appropriate question to ask, since the “category of negligent conduct” at issue is an alleged lack of reasonable care in the operation of a motor vehicle, and the “kind of harm experienced” was the respiratory condition suffered by appellant. The fact that Cassondra Hegyes was not yet bom at the time of the tortious conduct is outside the scope of the court’s analysis; if the condition she suffers from was sufficiently likely to result from negligent driving, a duty exists, and an inquiry questioning whether this plaintiff would have been foreseeably injured by this defendant must be determined by the jury as an element of proximate cause.
“The great majority of respiratory infections [in children] occur” in premature infants. (5 Lawyer’s Medical Cyclopedia of Personal Injuries & Allied Specialties (3d ed. 1986) § 37.24b, p. 106.) Moreover, there is a 10-fold increase in the death rate in premature infants as compared to full-term infants, and there is a corresponding increase in the rate of serious complications in such infants who survive premature birth; “[t]hey are prone especially to pulmonary infections and brain hemorrhage.” (Id. at § 37.17, p. 81.) Thus, it is reasonably foreseeable that premature birth would give rise to a serious injury similar to the one suffered by the appellant in the present case.
Also, it is also reasonably foreseeable that a pregnant woman would be a driver, passenger, or pedestrian who could be affected by an automobile operator’s failure to drive with reasonable care. Since this is the case, under California law any injury to the woman’s unborn infant would give rise to a valid cause of action on behalf of the infant for personal injuries sustained prior to birth. (See Scott v. McPheeters, supra, 33 Cal.App.2d 629.)
Having established that premature birth is reasonably likely to give rise to the “kind of harm experienced” by the appellant in this case, and that it is foreseeable that the class of persons to whom the plaintiff belongs would be affected by a negligent driver, the last question must be: is it reasonably foreseeable that a woman would suffer injuries in an automobile accident which would result in the premature birth of her child?
*1149Premature birth may result from premature labor or any of a variety of threats to maternal or fetal health which may require a physician-mediated premature delivery of the child, either by induced labor, or by Caesarean section. With regard to premature labor, in most cases the cause of the condition is unknown; it occurs, however, in 7 to 8 percent of all deliveries. (5 Lawyer’s Medical Cyclopedia, supra, § 37.17 at p. 81.) Trauma, either physical or emotional, has been found in some cases to be related to the time of premature labor, but “these factors are [considered] . . . extremely uncommon and are far outnumbered by natural causes.” (Ibid.) Nevertheless, due to maternal anxiety, many women are apt to attribute premature labor to such trauma.
Alternatively, an infant’s premature birth may be due to maternal or fetal injury which necessitates an early delivery. For example, a pregnant woman may be gravely injured or killed, and the infant will be delivered prematurely, if it is viable, in order to save its life. Or the fetus may be injured in the mother’s womb, and an early delivery is necessary to save its life through surgery.
A premature delivery due to either of the causes mentioned above is reasonably foreseeable. In the first situation, while the induction of premature labor by trauma is uncommon, it nevertheless occurs. (See, e.g., Drobner v. Peters (1921) 232 N.Y. 220 [133 N.E. 567, 20 A.L.R. 1503] [child born prematurely with serious injuries 11 days after mother fell into an open coal chute].) Moreover, the foreseeability of a risk does not turn exclusively on the likelihood of harm, but must take into consideration the reasonable person’s perception of the risk. Death due to an airplane crash is statistically unlikely, but is nevertheless reasonably foreseeable. Hence, simply because the public perception is that physical trauma may induce premature labor more often than it actually occurs does not make such an event unforeseeable.
The likelihood of grave injury or death as a result of an automobile accident caused by another’s negligence is clearly foreseeable. It is also foreseeable that an injury to a pregnant woman would be to a part of her body which does not immediately harm the fetus. In such an event, assuming the fetus is viable, it would be standard medical procedure to deliver the fetus prematurely to ensure its survival.
I therefore find that it is sufficiently likely the negligent operation of a motor vehicle would give rise to the “kind of injuries experienced” by the appellant in this case. Hence, under the foreseeability prong of the Rowland v. Christian analysis, I find nothing to overcome the presumption respondent owed the infant appellant a duty of reasonable care.
*11502. Certainty of Injury to Cassondra Hegyes
Similarly, there is no question that Cassondra Hegyes was injured. While premature birth in itself is no injury, attendant respiratory conditions in premature infants are potentially life-threatening. (See, e.g., Pan-American Casualty Co. v. Reed (5th Cir. 1957) 240 F.2d. 336; see also generally, 5 Lawyer’s Medical Cyclopedia, supra, §§ 37.16-37.17 at pp. 79-82.) Moreover, such injuries are often permanent or may require lengthy treatment or surgery to remedy. Hence, there can be no doubt that Cassondra has in fact suffered a very real injury.
3. The Closeness of the Connection Between Respondent’s Conduct and Appellant’s Injury
The closeness of the connection between the defendant’s conduct and the plaintiff’s injury, both directly and proximately, is generally a question of fact for the jury. (6 Witkin, Summary of Cal. Law (9th ed. 1988) Torts, § 967 pp. 356-357.) Since this case is before us on a demurrer, we may only rule on the sufficiency of the complaint as a matter of law. Thus, the jury indeed may determine the connection between the respondent’s allegedly negligent driving and Cassondra Hegyes’s injuries to be too attenuated because of intervening causes not apparent in the complaint. However, if a duty exists and the traditional elements of negligence, duty, breach, causation, and injury are properly pleaded, then appellant must be given her day in court to attempt to prove her case.
For the reasons stated above under the discussion of foreseeability, I do not think it possible to declare the connection between act and injury in this case is too attenuated as a matter of law. Indeed it is difficult to discern a relevant difference in closeness between the situation where a driver’s conduct injures a one-day pregnant mother in such a way she ultimately delivers a disabled child and one where the same conduct injures a woman who later conceives a child doomed to the same fate for the same reason.
4. The Degree of Moral Blame to Be Attached to the Appellant’s Alleged Conduct
A motor vehicle is a powerful engine of destruction unless handled with great care and responsibility. For this reason, the law regards operating a motor vehicle to be a privilege. A driver’s license is required especially so the only persons allowed to drive a car on public streets are those who have demonstrated they can operate an automobile safely and with reasonable care. The purpose of this requirement is an attempt to ensure the public safety and prevent injury to the driver and others. Thus, one who fails to *1151observe the standards necessary to accomplish this goal is putting his own and innocent lives at risk. Significant moral blame must inevitably attach one who operates something so dangerous to life and limb in a careless manner.
Assuming the truth of appellant’s allegations the respondent failed to exercise ordinary care in the operation of a motor vehicle, and this failure resulted in appellant’s injuries, an additional measure of moral blame attaches to respondent’s conduct. I agree with the Renslow court, “there is a right to be born free from prenatal injuries foreseeably caused by a breach of duty to the child’s mother.” (Renslow, supra, 367 N.E.2d at p. 1255.) A person who interferes with this right wrongfully deprives the infant of the opportunity to begin life free of injuries which would not have had existed but for the actor’s tortious conduct. Cassondra’s premature birth and resulting respiratory problems must be taken to have constituted serious injury to one who had no choice but to incur the one, and who may never experience life without the other. Thus, at least as much moral blame attaches to respondent’s conduct in this case as in that of any other automobile negligence case which seriously injures someone.
5. The Policy of Preventing Future Harm
There is, of course, nothing lost and everything to be gained from encouraging motorists to exercise reasonable care while driving. There already exists a strong public policy in favor of preventing injury due to negligent operation of a motor vehicle. To the extent a finding of liability in this case would encourage automobile operators to act with even greater care, the policy of preventing future harm to victims of automobile accidents, including postconceived children, would be advanced by such a finding.
6. The Extent of the Burden to the Defendant and the Consequences to the Community of Imposing a Duty to Exercise Reasonable Care While Driving
Neither the current respondents nor the community as a whole would be excessively burdened by a finding automobile operators owe a duty to children conceived after a tort is committed against their mother. Indeed the consequences for the community, if any, would be entirely positive.
Automobile drivers already have a duty to exercise ordinary care under the circumstances towards other drivers, passengers and pedestrians they may encounter. Yet our streets and highways still witness far too many deaths and injuries. Any extra burden placed on drivers by making them responsible to postconceived children—and it seems unlikely to be a *1152significant burden—would only serve to increase the degree of care drivers must exercise. I seriously doubt many would contend the present burden is so heavy and drivers already are so careful we should not increase the burden or enhance the degree of care any further than we already have. As for the community at large, the consequences, at worst and at best, would be fewer automobile accidents and thus fewer deaths and injuries. This would be a welcome—not an unfortunate—consequence.
Realistically, however, recognizing drivers have a duty toward postconceived children is unlikely to impose a significant new burden on the driving population nor achieve a significant improvement in the standard of care exhibited on our streets and highways. Compared to the millions of people toward whom drivers already owe a duty of care, the handful of post-conceived children whose injuries they might proximately cause represent an infinitesimal increment—like a single sliver of straw dropped on a haystack.
7. The Availability, Cost, and Prevalence of Insurance for the Risk of Injury to Postconceived Children
Not only is automobile insurance available and prevalent, it is required by state law. The risk is thus readily insurable. While the cost of insurance could significantly rise if there were a dramatic increase in the number of suits brought by postconceived children against negligent drivers, no such flood is likely. It seems extraordinarily improbable automobile accidents will injure enough women in such a way it causes injuries to their postconceived children to warrant an appreciable rise in the cost of automobile insurance.
8. Balancing the Factors
Upon balancing these factors I find the facts of the instant case do not warrant an exception to the general rule stated in Rowland, as a matter of law. I find the kind of injury alleged by appellant in this case is a reasonably foreseeable result of the respondents’ alleged negligent driving. Because the complaint avers a tangible, certain injury, the fact of the injury as pleaded is not in doubt. Respondents’ alleged activity carries a heavy measure of moral blame. The public policy of preventing injury due to automobile accidents is furthered by imposition of a duty of care on drivers to prevent injury to postconceived children. (See the economic analysis of these public policy considerations in fn. 4, ante.) Since the standard of care which drivers must exercise to prevent such injury is the standard which already exists towards other motorists and pedestrians, neither the respondent nor the public is burdened by the finding of a such a duty. Indeed, to the extent the burden is *1153increased so is the incentive to drive safely which would represent a benefit not a burden for the public. Finally, insuring drivers against harm caused by automobile accidents is one of the main functions of insurance in our society today and is required to be purchased by every California driver. There is no reason to believe the cost of automobile insurance would rise appreciably—if at all—were we to recognize drivers owed a duty toward postconceived children.
Only on the issue of the closeness of the connection between the respondent’s conduct and the appellant’s injury do I see issues of fact which may eventually foreclose a finding of liability in this specific case. Should the finder of fact determine appellant’s injuries were not directly or proximately caused by respondent’s conduct, there, of course, would be no basis for liability. This, however, is to be determined on the evidence presented by the parties below. It is an issue for the fact finder in the trial court not an issue of law to be decided on appeal.
Accordingly, on grounds of both stare decisis and application of well-settled principles for analyzing the duty issue under California law I conclude tortfeasors—including automobile drivers—owe a duty of due care which extends to postconceived children whose injuries are the proximate result of the tortfeasors’ acts. Having answered the sole issue presented on the appeal in this way, I would remand for further proceedings which might or might not establish the requisite causal connection.
A petition for a rehearing was denied October 23, 1991, and appellant’s petition for review by the Supreme Court was denied January 16, 1992. Mosk, J., was of the opinion that the petition should be granted.

The California Supreme Court obviously chose its authorities for this holding very carefully. It also avoided mentioning Jorgensen v. Meade Johnson Laboratories, Inc. (10th Cir. 1973) 483 F.2d 237 despite the fact this case frequently is mentioned as supporting the proposition postconceived children can recover for tortious acts which injure their mothers. A careful reading of the opinion reveals it merely acknowledges a defective product may give rise to a cause of action in strict liability even for children who were conceived after the product was manufactured but are harmed by it while in the womb. “If . . . tortious conduct occurring prior to conception is not actionable in behalf of an infant ultimately injured by the wrong, then an infant suffering personal injury from a defective food product, manufactured before his conception, would be without a remedy.” (Id. at p. 240.)
Unlike the broad rule and expansive rationale announced in the two opinions the California Supreme Court chose to cite, Renslow and Bergstreser, the Jorgensen court expressly limited its holding and its rationale to product liability cases based on a strict liability theory. By choosing to mention only Renslow and Bergstreser, and to disregard the contrary authority of Albala and the limiting authority of Jorgensen, the California Supreme Court evidenced it was adopting the rule and rationale of Renslow and Bergstreser which apply with equal force to all negligence actions.

The briefs also discuss other out-of-state cases decided after the California Supreme Court ruling in Turpin and thus having no direct bearing on our interpretation of the present law in California. Nevertheless, they are worthy of mention. In McAuley v. Wills (1983) 251 Ga.3 [303 S.E.2d 3], an automobile accident case, the Georgia Supreme Court acknowledged “at least in some situations, a person should be under a duty of care toward an unconceived child,” but held under the undisputed facts of that case there was an unforeseeable intervening act which meant “the defendant’s negligence was not the proximate cause of the plaintiff’s injury." The unforeseeable intervening act was the physician’s malpractice while delivering the plaintiff infant to the paraplegic mother. (This contrasts with the instant case where under the allegations of the complaint the plaintiff’s injuries resulted from the fact defendant’s negligent harm to the mother meant the infant had to be delivered prematurely, not from any malpractice in the manner of her delivery.) In Monusko v. Postle (1989) 175 Mich.App. 269 [437 N.W.2d 367], the court expressly rejected the reasoning of Albala and allowed a postconceived child a cause of action against medical practitioners who failed to test or immunize her mother against rubella. The mother caught rubella during pregnancy and the plaintiff was born with severe handicaps. Finally, in Enright v. Eli Lilly (1991) 77 N.Y.2d 377 [568 N.Y.S.2d 550, 570 N.E.2d 198], the New York Court of Appeals predictably followed its Albala decision and denied a cause of action to the granddaughter of a woman who ingested the drug DES and allegedly suffered premature birth and its consequences as a result.

Although not determinative, I also note this view is shared not only by the California Supreme Court and the majority of courts which have spoken to this issue but is also supported by the overwhelming majority of commentators, including the leading scholars in the field of tort law—Prosser & Keeton. (Prosser and Keeton, The Law of Torts, supra, § 55 and 3 Harper et al., The Law of Torts (2d ed. 1986) § 18.3.) Other authorities supporting the principle that tortfeasors should owe a duty to postconceived children include Case and Comment, Report of the Scottish Law Commission on Antenatal Injury, (1974) Jr. Rev. 83; Gordon, The Unborn Plaintiff (1965) 63 Mich. L. Rev. 579; Note, Torts Prior to Conception: A New Theory of Liability (1977) 56 Neb.L.Rev. 706; Robertson, Toward Rational Boundaries of Tort Liability for Injury to the Unborn: Prenatal Injuries, Preconception Injuries and Wrongful Life (1978) Duke L.J. 1401; Comment, A Step Backward for the Infant Plaintiff in Preconception Tort Actions: Albala v. City of New York (1982) 15 Conn. L. Rev. 161; Comment, Preconception Tort as a Basis for Recovery (1982) 60 Wash. U.L.Q. 275; and Note, Torts-Preconception-Infant’s Right to Cause of Action (1982) 50 Tenn. L. Rev. 195.

The idea, espoused by the court in Rowland, of a presumptive duty of care finds additional support in the various economic analyses of tort law. (See, e.g., Demsetz, When Does the Rule of Liability Matter? (1972) 1 J. Legal Stud. 13; see also Landes & Posner, Causation in Tort Law: An Economic Approach (1983) 12 J. Legal Stud. 109; Posner, Economic Analysis of the Law (3d ed. 1986) p. 187.) Economic analysis limits it focus to a single societal value— economic efficiency—rather than the full scope of values embraced in Rowland. Nonetheless, it is an important value and one worth weighing when deciding the overall merits of a given common law legal rule.
In one such analysis Judge Posner stated as a general rule: “[a] defendant owes to those whom he might chance upon and injure a duty to exercise due care.” (Posner, A Theory of Negligence (1972) 1 J. Legal Stud. 29, 38.) The unqualified nature of this statement is justified by an examination of negligence law from a cost/benefit perspective.
Most proponents of the economic approach to negligence use as a starting point the formulation of the negligence standard provided by Judge Learned Hand in United States v. Carroll Towing Co. (2d Cir. 1947) 159 F.2d 169. In a negligence case, according to Hand, the judge or jury should attempt to measure three things: the magnitude of the loss if an accident occurs (L), the probability of an accident occurring (P), and the economic burden of taking precautions to prevent the accident (B). (See, e.g., Posner, A Theory of Negligence, supra, 1 J. Legal Stud. 29.) If B is less than P times L, then the failure to take those precautions is negligence. By corollary, *‘[i]f the cost of safety measures or curtailment—whichever cost is lower—exceeds the benefit in accident avoidance to be gained by incurring that cost, society would be better off, in economic terms, to forgo accident prevention.” {Id. at p. 32.)
Because the economic purpose of tort law is to assure the most efficient level of care at the least possible expense, all the effects of a person’s actions, even unintended ones, must be accounted for in determining quantities for B, P, and L in the negligence equation. Only when these values accurately reflect the true cost of an accident, the precautions necessary to avoid it, and the actual probability of it occurring may a realistic efficiency assessment be made. In other words, to deny recovery to anyone a tortfeasor injures—including postconceived children—artificially reduces the “L” factor (the cost of the accident) and thus distorts the equation in such a way the tortfeasor will have an insufficient incentive to make adequate investments in accident avoidance. This principle is illustrated by Posner in justifying the imposition of liability on a defendant for injuries inflicted on a plaintiff with an “eggshell skull.” The issue in such a case is not whether the defendant owes a duty of care to the plaintiff, since a duty is presumed. Rather, the question is whether he should be held liable for the full extent of damages even though the extent could not be foreseen. According to Posner:
“[T]here is a good reason for distinguishing . . . between the fact of injury and its extent. We want the total liability of negligent injurers to equal the total cost of their accidents. If instead of attempting to determine damages in each case on an individual basis, we used an average figure (the injury [an average man] . . . would have sustained in an accident of the same type), then we would be overcompensating some (those who are stronger or healthier than average), as well as undercompensating the weaker. But overcompensating for injuries *1145may cause the accident rate to rise. Insurance companies will not insure a building for more than it is worth lest arson be encouraged. Nor should the law of negligence encourage the strong to court injury by overcompensating them when an injury occurs. But then the weak must not be undercompensated, lest the total liability of negligent injurers fall short of the total cost of their accidents.” (Posner, A Theory of Negligence, supra, 1 J. Legal Stud. 29, pp. 47-48, italics added.)
The same principle applies to the issue of duty. In order to ensure the social costs of an accident are minimized (and efficiency is maximized) it is necessary that all the consequences of the injurer’s actions be factored into the calculus. (In economic terms, all externalities must be internalized.) Accordingly, a person driving an automobile should owe a duty to, and thus be responsible for the costs of injuries to, anyone whose injuries are proximately caused through the negligent handling of his automobile. But that duty should not extend to those whose injuries did not proximately result from his negligence. For, if the damage was not caused by the defendant’s actions, the assessment of B, P, and L in the Hand equation will be inaccurate, and the calculated cost of accidents will be overestimated.

I note despite the difficulty of assessing damages in such a case, California recognizes a cause of action for wrongful life. (Curlender v. Bio-Science Laboratories, supra, 106 Cal.App.3d 811; see also Turpin v. Sortini, supra, 31 Cal.3d 220.)

It is interesting to note a rule such as that expounded in Ballard finds support in the economic analysis of tort law. (See fn. 4, ante.)