Court Opinion

ID: 9693720
Source: CourtListenerOpinion
Date Created: 2023-08-25 16:58:08.639893+00
Date Added: 2024-06-11T12:08:17.744768
License: Public Domain

HANDLER, J.,
dissenting.
This case returns us to our longstanding struggle to explain and define the limits of tort actions by handicapped children born as the result of medical malpractice. Since 1967 when the Court first considered whether the failure to warn parents that their child would be born with serious birth defects gave rise to tort damages, the problem of valuing life against non-existence has perplexed the Court. That parents denied the opportunity to terminate a pregnancy can collect damages for pain and suffering and that both parents and children can recover extraordinary medical expenses are now settled. Nonetheless, although our treatment of these actions has evolved significantly, this case demonstrates that the metaphysical and logical tangles inherent in this area of law continue to stand in the way of alleviating the crushing burdens placed on families as the foreseeable result of medical malpractice.
I dissent based on my conclusion that the majority here takes an unnecessary step back from our decision in Procanik v. Cillo, 97 N.J. 339, 478 A.2d 755 (1984). In Procanik we held that children with severe birth defects born as the result of *131medical malpractice could recover special damages for their extraordinary medical expenses. The majority holds that plaintiff has no cause of action for medical expenses under Procanik because she was born before the Supreme Court decided Roe v. Wade in 1973.
The majority decision is based largely on the reasoning that prior to Roe v. Wade public policy in New Jersey valued life over non-existence. Ante at 126; Gleitman v. Cosgrove, 49 N.J. 22, 30, 227 A.2d 689 (1967). The majority decision does not deny the manifest conclusion that absent medical malpractice, the child would not have been born. The facts alleged clearly support a finding that the mother’s life was in danger; that evacuating her uterus was an appropriate and lawful medical option; and that had it been carried out, the fetus would not have survived. The majority’s holding is not based on the conclusion that Judy Hummel had no choice but to proceed with the pregnancy, but rather on the reasoning that whatever choice she did have could have been justified only by the goal of protecting her life or health. Because she did not yet have the right granted in Roe v. Wade to abort the fetus to prevent the birth of a severely handicapped child, she could not maintain an action against her doctor or hospital for denying her that choice. Ante at 127-28.
I would hold that when medical malpractice results in the birth of a severely handicapped child who would not otherwise have been born or where such malpractice denies a parent an actual choice to decide whether to proceed with a pregnancy, those responsible are liable for the foreseeable damages. The duty of medical professionals is to assure that patients control the course of their treatment. To the extent that medical professionals ignore the choices of patients or deny patient actual choices, they are responsible for the foreseeable results. To collect special damages plaintiffs must necessarily prove that absent malpractice, the child would not have been born. In cases arising before Roe v. Wade proof of causation and foreseeability is more difficult because abortions were available *132under far more limited circumstances. Nonetheless, where a plaintiff can demonstrate that an abortion was an available medical option denied by malpractice, recovery should be allowed.
I
The case comes before the Court on a dismissal for failure to state a claim, and therefore the allegations must be accepted as true and accorded the benefit of all reasonable inferences. Portee v. Jaffee, 84 N.J. 88, 90, 417 A.2d 521 (1980). The facts that plaintiff alleges support two possible theories of medical malpractice. The applicable standard of care may have required imfnediate evacuation of Judy Hummel’s uterus when it was discovered that she was carrying a second fetus. The other possibility is that there was more than one acceptable course of action but that Hummel was denied the opportunity to choose how she would be treated.
Hummel entered St. Michael’s Hospital on October 1, 1971, with vaginal bleeding and a 103 degree temperature. The next day she gave birth to a macerated stillborn fetus. Her treating physician, Dr. Reiss, told her that if she did not deliver the placenta shortly, he would perform a D & C operation to clear the uterus. As the day went on, the placenta did not appear and her condition worsened. Using an x-ray Reiss determined that a second fetus remained in the uterus.
At that point Hummel had a intrauterine infection, which threatened her life. According to Reiss, “The presence of the fetus in the uterus was a danger to her well-being. Good medicine dictated that the fetus be removed from the uterus to aid her recovery. However, under no circumstances did this mean the fetus had to be destroyed.” Reiss, who settled with plaintiff and is no longer a defendant, asserts that there were three treatment options at that point. He could clear the uterus immediately, either through a caesarean section or the use of a drug called Pitocin, or he could wait for the child to *133develop and deliver it vaginally. The fetus would not have survived either of the first two options.
Hummel was aware that her condition posed a danger to her life. She also claims that Reiss told her that if the fetus were delivered at some future point and survived, it would probably be very handicapped. She and her now-deceased husband resolved that her uterus should be evacuated and the pregnancy aborted.
At that point the hospital intervened. After a series of meetings among members of the medical and administrative staff, certain priests and probably her husband, a decision was made to leave the fetus in her uterus and wait for it to develop in order to give it a chance to live. Hummel did not participate in that decision. In the meantime her condition worsened, to the extent that she received the Last Rites of the Roman Catholic Church. When “the decision to continue her pregnancy was revealed to her, she was upset but did nothing” believing that she had no other choice. Hummel v. Reiss, 247 N.J.Super. 502, 506-07, 589 A.2d 1041 (App.Div.1991).
On October 13th, Reiss delivered the child vaginally. Born after twenty-five weeks of gestation, Kelly weighed one pound eleven ounces. Judy Hummel left the hospital two days after giving birth, and recovered physically. The child was born with severe physical and neurological damage and remained at the hospital for three months. The child is now a twenty-year old woman with psychomotor retardation, multiple handicaps, neurological impairments, and blindness. She lives at home with her mother and siblings.
When viewed most favorably to plaintiff, the allegations support the conclusion that the failure to evacuate the uterus immediately breached the applicable standard of care. According to her proffered expert, “evacuation of the uterus including the second fetus even in the second trimester was required in the septic situation for the benefit of the mother.” Therefore unlike our previous cases, which involved a failure to warn of *134likely birth defects, the facts of this case suggest that the failure to abort itself may have constituted malpractice. Moreover, even if the treatment option selected was consistent with applicable standards of care, the failure to inform Hummel about the options or allow her preference to be determinative may have constituted malpractice.
II
The outcome of this case depends in large measure on whether Judy Hummel was denied an opportunity to abort her pregnancy. That question and implications that follow from the answer in turn depend on the nature of the duties owed to Hummel by the medical professionals involved in her treatment.
The right of competent adults fully to control the course of their medical treatment is well established. In re Conroy, 98 N.J. 321, 346, 486 A.2d 1209 (1985); Perna v. Pirozzi, 92 N.J. 446, 457 A.2d 431 (1983). That right to self-determination applies equally to the decision to operate and to the rejection of a course of action. Id. 98 N.J. at 347, 486 A.2d 1209. Neither physicians nor hospitals may override or ignore the choices of patients or their guardians, nor may either withhold information essential to their informed consent. Cf. Strachan v. John F. Kennedy Memorial Hosp., 109 N.J. 523, 538 A.2d 346 (1988) (Strachan) (holding hospital liable, when in order to preserve organs of brain-dead child, it refused parents’ demand that child be taken off life-support).
The right of patients to make subjective treatment decisions presupposes that they be told about and understand the available options and have all the relevant information necessary to make an informed choice. Id. 98 N.J. at 347, 486 A.2d 1209. By allowing parents and children to recover damages when births occur as the result of inadequate genetic screening or a failure to diagnose, the Court recognizes that the duty to inform is expansive. Schroeder v. Perkel, 87 N.J. 53, 63, 432 A.2d 834 (1981). Indeed, the duty to obtain and pass on *135relevant information is coextensive with the reasonable foreseeability of the consequences of a failure to do so. Id. at 63, 432 A.2d 834. Although the failure to provide essential information can do independent harm, Procanik, supra, 97 N.J. at 361, 478 A.2d 755 (Handler, J., concurring in part and dissenting in part), the primary effect of such, a failure is to deprive patients of a meaningful opportunity to control their treatment.
Dr. Reiss stated that when the second fetus was discovered in Hummel’s uterus, he had to make a difficult decision about which course of treatment to pursue. Under accepted medical practices and legal principles, however, such a decision necessarily rested with Hummel, not with her doctor or her hospital. To suggest that the doctor’s duty in deciding whether to perform an abortion was owed to the mother alone begs the question. The doctor’s duty was to inform the mother of the medical options and take informed direction from her. See ibid. (“it is the doctor’s role to provide the necessary medical facts and the patient’s role make the subjective treatment decision based on his understanding of those facts.”)
The hospital shared with Dr. Reiss the duty to respect Hummel’s right to control her treatment. As we have recognized in the context of terminally ill patient care, a patient does not lose “the right to choose among medical alternatives” when he or she enters a medical facility. Matter of Jobes, 108 N.J. 394, 425, 529 A.2d 434 (1987); see also Strachan, supra, 109 N.J. at 530, 538 A.2d 346 (recognizing hospital’s duty “to act reasonably in the face of plaintiff’s request to turn over the [child’s] body”).
Even if the decision on which course of treatment to follow involved only an objective medical question of what would best promote her health, in the absence of an emergency, Hummel had the right to choose the treatment. In this case her participation was even more crucial because the decision on whether to abort or allow the fetus to develop further did not turn exclusively on her health. If her claims prove accurate, her *136decision to have her uterus evacuated was overridden by the hospital on grounds that had nothing to do with her life or health. Her life apparently was put in greater risk in order that the child might live. We can only speculate at this point about the role that the child’s potential handicaps played in the discussions that led to the ultimate decision.
Nonetheless, the decision clearly involved not only complicated medical judgements about the condition of both Hummel and the fetus, but also difficult moral questions involved in weighing the value of the mother’s life against the potential life of the child. The decision may also have raised legal issues concerning the limits of abortion law at that time. See, Gleitman, supra, 49 N.J. at 56, 227 A.2d 689 (Weintraub, C.J., concurring and dissenting) (discussing whether abortion to prevent the birth of children with birth defects was lawful in 1967). Because the decision involved profound moral and personal issues, it was one that only Hummel could make. Given her right to be fully informed, she surely had the right to know the condition of the fetus she was carrying inside her womb. Once given that information she had the right to decide whether to undergo an abortion, and in making that decision the right to consider the implication of bringing a child to life with severe birth defects.
We recognized in Procanik, supra, that negligence in so-called “wrongful birth” and “wrongful life” cases is actionable because it “deprive[s] the parents of the choice of terminating the pregnancy and of preventing the birth of the infant plaintiff.” 97 N.J. at 348-49, 478 A.2d 755. The choice denied Hummel was more complicated than that denied the parents in our previous cases. It pitted her life against the potential and potentially diminished life of her child. Whereas the choice to abort was denied the parents in our previous cases by negligent omissions, in this case medical personnel affirmatively took that choice away from Hummel. Moreover, the apparent malpractice here took place under the intense pressure of a medical emergency. Those differences, however, should not diminish *137what is common to both situations: that a rightful choice involving difficult moral and practical considerations was taken from parents resulting in the birth of a severely-handicapped child.
The choice denied Hummel to terminate her pregnancy should not be viewed in the abstract. Even if women in New Jersey did not have the right as a general matter to chose abortion in 1971, Judy Hummel had the right to an abortion under the specific circumstances of her pregnancy. The availability of an abortion should have been explained to her by her physician. She should have been given the medical information necessary to make an informed decision with a full understanding of the implications of each option. Nothing in the preRoe statute or case law shifted medical decisions from patients to doctors or required that either have a pure heart or mind in making those decisions. If, after being fully informed, Hummel chose to have an abortion she should have either been provided one or been transferred to a hospital that would perform the appropriate treatment.
Ill
In his dissent in Gleitman, Justice Jacobs called on the Court to acknowledge that malpractice committed against a pregnant woman caused harm not only to the woman but also to her family. 49 N.J. at 50, 227 A.2d 689. My own dissent in Berman, supra, elaborated on the familial character of the tort: “[T]he duty they owed Mrs. Berman enveloped a duty to the unborn child. The breach of that duty affects both.” 80 N.J. at 444, 404 A.2d 8. In Schroeder, supra, a majority of the Court embraced the view that “a wrongdoer who causes a direct injury to one member of the family may indirectly damage another.” 87 N.J. at 64, 432 A.2d 834. Justice Pollock wrote eloquently: “A family is woven of the fibers of life; if one strand is damaged, the whole structure may suffer. The filaments of family life, although individually spun, create a *138web of interconnected interests.” Id. at 63-64, 432 A.2d 834. Lastly, in Procanik we extended the web of protection to cover claims brought directly by handicapped children: “When a child requires extraordinary medical care, the financial impact is felt not just by the parents, but also by the injured child.” 97 N.J. at 351, 478 A.2d 755. Although the doctor’s traditional duty is to his or her patient, the Court recognized that that duty extends to the child as a family member who shares the burden of defendant’s malpractice.
Until Procanik the Court could not fully reconcile itself with the idea that a child might have a negligence claim for having been wrongfully born. A majority of the Court had found impossible and even repugnant the measuring of the value of a life, even one seriously impaired, against the “utter void of nonexistence.” Berman, supra, 80 N.J. at 427, 404 A.2d 8; Gleitman, supra, 49 N.J. at 28, 227 A.2d 689. Parents might maintain actions for wrongful birth but the children themselves were alive only by the grace of that negligence. How could they claim any damage? Berman, supra, 80 N.J. at 429, 404 A.2d 8.
In Procanik, supra, the Court recognized that allowing impaired children recovery is based not on metaphysics, “on the concept that non-life is preferable to an impaired life,” but on “the needs of the living.” 97 N.J. at 353, 478 A.2d 755. We said, “We se,ek only to respond to the call of the living for help in bearing the burden of their affliction.” Ibid.
Although the Court in Procanik refused to allow impaired children the full measure of their damages, that decision nonetheless brought us full circle back to Justice Jacobs’ original dissent in Gleitman. He had written there that “while logical objection may be advanced to the child’s standing and injury, logic is not the determinative factor and should not be permitted to obscure that he has to bear the frightful weight of his [handicap] throughout life.” 49 N.J. at 50, 227 A.2d 689. Echoing his words, Justice Pollock wrote for the Court in *139Procanik, supra, that the “[l]aw is more than an exercise in logic, and logical analysis, although essential to a system of ordered justice, should not become an instrument of injustice.” 97 N.J. at 351, 478 A.2d 755.
As with the children in our previous cases, Kelly Hummel, with her devastating birth defects, was born as the proximate and foreseeable result of medical malpractice. Both Dr. Reiss and St. Michael’s Hospital owed a duty to Judy Hummel to respect her choices concerning treatment; that duty encompassed Kelly Hummel given an understanding of the familial nature at these torts and the fact that her birth was the predictable result of the defendants’ negligence. After some struggle we have succeeded in seeing through the logical and metaphysical dilemmas inherent in evaluating these claim in order to focus on the central principles of tort law. Schroeder, supra, 87 N.J. at 65, 432 A.2d 834; see also Berman, supra, 80 N.J. at 432, 404 A.2d 8 (“As in all other cases of tortious injury, a physician whose negligence has deprived a mother of this opportunity should be required to make amends for the damage which he has proximately caused.”). We hold persons liable for the proximate and foreseeable results of their negligence and do not immunize medical professionals from liability because the harm they cause, although measurable, implicates fundamental questions about life and death. There is no reason or justice in refusing to apply these same principles to the claim brought by Kelly Hummel.
IV
The majority would deny recovery notwithstanding the foreseeability of the harm and the extraordinary expenses visited on plaintiff and her family. It would do so because the malpractice was committed in 1971, two years before the United States Supreme Court decided Roe v. Wade. The reasoning that makes Roe v. Wade the determining factor in whether Kelly Hummel has a cause of action is sound. In 1971 parents *140had no right to chose nonexistence over life. The birth of a child with severe birth defects was a matter of fate rather than choice. Because women had no choice to abort except to preserve their own health or life, the duty of a treating physician or hospital extended no further than to protect the health of the pregnant woman.
Although this approach has a certain logic, it does not do justice to the actual choice denied Judy Hummel nor to the overwhelming implications of the malpractice committed against her. Dr. Reiss and St. Michael’s Hospital decided to bring Kelly Hummel into this world against the wishes of her parents. In doing so they violated standards of acceptable care and put Judy Hummel’s life in danger. In overriding the decision of their patient, they either knew or should surely have known that Kelly would be born with devastating birth defects. That defendants should be able to make such a decision and bear none of the profound emotional and ruinous financial consequences that result is not just.
That their negligence took place before Roe v. Wade was decided diminishes neither the wrongfulness of their conduct nor the immense medical costs associated with caring for Kelly. Kelly is denied recovery because hypothetically her mother could not have considered the possibility that Kelly would be born with birth defects in a decision that she was never allowed to make. Surely a triumph of logic over justice.
I would reverse and remand for trial on the issues of negligence, proximate causation, foreseeability, and damages.
For affirmance — Justices CLIFFORD 'POLLOCK, O’HERN, and GARIBALDI — 4.
For reversal and remandment — Chief Justice WILENTZ, and Justices HANDLER and STEIN — 3.