Court Opinion

ID: 9737929
Source: CourtListenerOpinion
Date Created: 2023-08-26 19:37:09.70272+00
Date Added: 2024-06-11T07:24:02.526231
License: Public Domain

Riley, C.J.
(dissenting). I would hold that a wrongful death action1 may not survive a motion for summary disposition where it is uncontested that the plaintiff cannot show that defendant’s negligence caused the decedent’s death, and will produce evidence only that the decedent would have had an increased chance of survival if the defendant, as in this case, had not negligently failed to insert an intravenous line before or immediately after administering saddle block anaesthesia.2 Where plaintiff cannot show that defendants’ omission was probably a cause of the death of Nena Falcon, the degree of certitude which would justify the imposition of liability on defendants is lacking. The recognition of mere chance as a recoverable item of loss fundamentally contradicts the essential notion of causation. By definition, the lost chance theory would compensate *474plaintiff for a mere possibility that defendants’ omission caused the death of Nena Falcon.
i
This is a wrongful death action grounded in allegations of medical malpractice. The action arises from the death of Nena J. Falcon on March 22, 1973. Ms. Falcon, then nineteen years old, was delivered of a healthy child at defendant Memorial Hospital, under the care of defendant Dr. S. N. Kelso, Jr. At the request of the decedent, Dr. Kelso administered a saddle block anaesthetic prior to delivery. No intravenous line was inserted before or after the administration of the spinal anaesthetic. Immediately after the delivery of the child at 6:39 a.m., and before the placenta was delivered, Nena Falcon coughed and went into a convulsive state. Nurse Norma Denny attempted to obtain a blood pressure reading but there was none, indicating cardiac arrest. At this time the decedent had no respirations. According to Dr. Kelso, the patient died within a few minutes. Efforts to resuscitate her were unsuccessful. Attempts to start an intravenous line were unsuccessful. A "cut down” into a central vein was also attempted, but fluids could not be run into the decedent’s circulatory system because there was no circulation at this time. The autopsy revealed that the decedent had suffered an amniotic fluid embolism, an unpredictable and life threatening complication of pregnancy. There is no known way to prevent amniotic fluid embolism. While there are certain predisposing factors, it can occur in a person who is apparently healthy and normal.3 *475The primary cause is a rent in the amnion4 or chorion,5 together with pressure sufficient to force the amniotic fluid into the circulatory system.
Plaintiff does not allege that defendant’s negligence caused the embolism. Rather, plaintiff claims that the survival rate for women suffering this complication is 37.5 percent, but that due to defendant’s negligence, Nena Falcon was deprived of that chance.
Plaintiff’s claim is based primarily on the testimony of Dr. Ezzat Abouleish. Dr. Abouleish testified at the deposition that spinal anaesthesia should not be given without an intravenous line because spinal anaesthesia can lead to a decrease in blood pressure or respiratory depression. According to Dr. Abouleish, an intravenous line, had it been in place, would have provided Ms. Falcon’s only chance of survival. Dr. Abouleish could not say that the failure to use an intravenous line was the cause of Ms. Falcon’s death. He testified, however, that her chances of surviving the embolism would have been better if she had an intravenous line in place and fluids going into her bloodstream. If an intravenous line had been in place, Ms. Falcon could have been given drugs to stimulate her heart or dilate her bronchi.
Dr. Abouleish testified that the overall survival rate for women suffering amniotic fluid embolism is 37.5 percent. This number was calculated in the following manner: Of one hundred patients experiencing this complication, fifty will die within one hour and fifty will survive. Of the fifty survivors, twenty-five will develop a blood coagulation prob*476lem which will be fatal to half of those developing the problem. Thus, the statistical survival rate for amniotic fluid embolism is 37.5 percent. Dr. Abouleish testified that for a patient to have even that chance of survival, an intravenous line is essential.
Plaintiff also relies on the deposition testimony of Dr. Thomas DeKornfeld. Dr. DeKornfeld generally agreed with Dr. Abouleish’s accounting of the survival statistics for women suffering amniotic fluid embolism, although he would not place the survival rate precisely at 37.5 percent. Dr. De-Kornfeld testified that an intravenous line should be started immediately after the administration of a spinal anaesthetic, so that any complication arising from the spinal anaesthetic could be managed by injecting medication intravenously. While Dr. DeKornfeld opined that it was clearly inappropriate not. to insert an intravenous line in the decedent, he was "not certain” that the presence of an intravenous line would have made any difference. When questioned further, DeKornfeld stated that intravenous infusion very likely would have made little if any difference in this case, but he conceded that "[t]here may have been a chance . . . .” DeKornfeld reiterated that opinion in cross-examination: He did not believe the presence of intravenous infusion would have materially affected the outcome, but he could not say it was inconceivable that an intravenous line might have changed the ultimate outcome.
A trial was held on January 7, 8 and 9, 1985. The trial ended with a directed verdict in favor of defendants after the trial court ruled that plaintiff had failed to present any expert testimony regarding the applicable standard of care for the doctor or nurse-anesthesiologist. That ruling was based on the trial court’s determination that Drs. *477Abouleish and DeKornfeld were not qualified to testify to the relevant standards of care. The Court of Appeals reversed the order granting the directed verdict, holding that both Drs. Abouleish and DeKornfeld were qualified to testify regarding the standard of care in Monroe, Michigan, or in similar communities.
On remand, defendants moved for summary disposition pursuant to MCR 2.116(C)(10).6 Defendants argued that, since plaintiff conceded that the decedent’s chance of survival was only 37.5 percent, under the best possible circumstances and in the absence of any negligence, plaintiff could not establish that any negligence by the defendants was the proximate cause of Nena Falcon’s death. The trial court granted summary disposition in favor of defendants, stating that plaintiff could only prove "that the wrongful acts or omissions of the defendants caused her to lose a chance at life (37.5 percent), but could not prove that the defendants’ acts or omissions caused her death.”
The Court of Appeals reversed. Falcon v Memorial Hosp, 178 Mich App 17; 443 NW2d 431 (1989).
ii
The decision of the Court of Appeals would require a plaintiff alleging medical malpractice to show only that a negligently omitted treatment or *478procedure "had the potential for improving the patient’s recovery or preventing the patient’s death.” 178 Mich App 26. The Court of Appeals held that "while a plaintiff must show some probability that the treatment would be successful, that probability need not be greater than fifty percent.” Id., pp 26-27. The analysis of the Court of Appeals turned on the meaning of the word "probability” in two cases decided by this Court.
In Rogers v Kee, 171 Mich 551; 137 NW 260 (1912), the plaintiff’s proofs showed that the defendant physician failed to diagnose a fractured neck and femur. The Court in Rogers noted that the defendant not only had failed to diagnose the plaintiff’s fractures, but had issued three successive diagnoses of conditions that the plaintiff did not have, and treated him for these conditions. Id., p 558. The Court stated that pain and suffering from a wrong treatment are elements of damage, and further noted that some of the advice given could actually have been injurious to the plaintiff’s condition. Id. On the basis of its conclusion that a jury could have found a better result probable but for defendant’s negligence, the Court held that the case was properly submitted to a jury:
[A] patient suffering from such an injury, on calling a physician, is entitled to approved methods of treatment from which experience of the profession indicates beneficial results are probable and to be anticipated; and, if not an entire recovery, a better ultimate condition than if left to chance. If so, can it not be legitimately inferred by a jury that plaintiff, a strong man, who, untreated and with his recovery left to chance, "shows as good results as would ordinarily obtain in a patient of his age under skillful treatment,” if properly and skillfully treated would, in all probability, *479have a better recovery and be in yet better condition? We think such testimony presents an issue of fact for the jury—on probability, it is true. The issues of sickness and healing, life and death, are too uncertain to be otherwise forecast, but negligence which deprives a man of such probability is more than injuria sine damno. [Id., pp 561-562.]
Although the Rogers Court cited a definition of injury to the plaintiff as "[a]ny want of the proper degree of skill or care which diminishes the chances of the patient’s recovery, prolongs his illness, increases his suffering, or, in short, makes his condition worse than it would have been if due skill and care had been used,” it based its conclusion on an assessment of testimony tending to show that with proper treatment, "a bony union was possible and a better fibrous union probable . . . .” Id., p 562 (emphasis added).
This Court again considered the problem of causation in a medical malpractice case in Harvey v Süber, 300 Mich 510; 2 NW2d 483 (1942). In Harvey, the negligence of the defendant doctors resulted in an inaccurate diagnosis of the course of the bullet that struck the decedent. Id., p 520. The Court inferred from the record that the doctor who initially treated the decedent thought he felt the bullet under the skin on the right side of the decedent’s abdomen. The x-rays revealed a bullet on the left side, but the chief of the x-ray department reversed the markings of left and right upon discovering that the treating doctor disagreed with his diagnosis finding a bullet on the left side. Id., p 513. The decedent died after eighteen hours. The autopsy revealed blood in the abdomen sufficient to cause death. It also revealed that the bullet which had entered at the right back had traveled forward from right to left, lodging in the upper left side of the abdominal cavity. Id., p 515. The *480bullet had traveled through the intestines causing numerous perforations. Id. There was testimony that only by surgery could the hemorrhaging have been stopped. The Court in Harvey found sufficient evidence to support a finding of proximate cause, finding proof of "probability” sufficient:
There is testimony in the record that there was a probability that an operation would have saved Harvey’s life. Therefore the negligent diagnosis could be said to have been the proximate cause of the death. [Id., p 520.]
The Court of Appeals carefully considered both Rogers and Harvey, and concluded that the test of "probability” employed in those cases was not an inquiry whether an event was more likely than not to happen. Id. The Court of Appeals noted that "the word 'probability’ . . . also refers to the relative chances of an event happening, whether that 'probability’ be low or high.” 178 Mich App 26. Thus, the Court concluded, "while a plaintiff must show some probability that the treatment would be successful, that probability need not be greater than fifty percent.” Id., pp 26-27.
That the Court of Appeals misconstrued the rule of Harvey and Rogers is made perfectly clear by the Harvey Court’s approval of an instruction which required the jury to find by a preponderance of the evidence that surgery would "with reasonable probability” have saved the decedent’s life:
"[Y]ou may not return a verdict for the plaintiff if he has shown only that surgical intervention might possibly have saved the life of Garfield Harvey, but, on the other hand, it is not incumbent on the plaintiff to show that to a certainty surgical intervention would have saved his life. It is sufficient if the plaintiff by a preponderance of *481the evidence has satisfied you that surgical intervention would with reasonable probability have saved his life . . . [300 Mich 521. Emphasis added.]
"Probability” thus means neither certainty nor mere possibility. The Court of Appeals conclusion that an omitted procedure need only have the potential for preventing the death necessarily reduces the degree of certitude which is inherent in the notion of causation from "probability” to mere possibility.7 The "lost chance of survival” theory urged by plaintiff thus represents not only a redefinition of the threshold of proof for causation, but a fundamental redefinition of the meaning of causation in tort law. To determine the wisdom of that course, we look to the law of other jurisdictions.
hi
The seminal case in the development of the lost chance of survival theory is Hicks v United States, 368 F2d 626 (CA 4, 1966). Hicks itself is not a lost chance of survival case, as there was testimony that if the defendant had not negligently failed to diagnose the decedent’s intestinal obstruction, she would have survived. In dicta, the court wrote:
When a defendant’s negligent action or inaction has effectively terminated a person’s chance of survival, it does not lie in the defendant’s mouth to raise conjectures as to the measure of the chances that he has put beyond the possibility of *482realization. If there was any substantial possibility of survival and the defendant has destroyed it, he is answerable. Rarely is it possible to demonstrate to an absolute certainty what would have happened in circumstances that the wrongdoer did not allow to come to pass. The law does not in the existing circumstances require the plaintiff to show to a certainty that the patient would have lived had she been hospitalized and operated on promptly.[8] [Id., p 632.]
The court in Hicks analogized to the "lost seaman” case of Gardner v Nat’l Bulk Carriers, Inc, 310 F2d 284 (CA 4, 1962), cert den 372 US 913 (1963), where the court recognized a duty on the part of a ship’s master to use every reasonable means to save the life of a man overboard. The court rejected the defendant’s contention that no proximate cause was shown, finding proximate cause implicit in the breach of the duty:
[T]he duty would be empty if it did not itself embrace the loss as a consequence of its breach. Once the evidence sustains the reasonable possibility of rescue, ample or narrow, according to the circumstances, total disregard of the duty, refusal to make even a try, as was the case here, imposes liability. [Id., p 287.]
In Hamil v Bashline, 481 Pa 256; 392 A2d 1280 (1978), the Pennsylvania Supreme Court relied on *483§ 323(a) of the Restatement of Torts, 2d,9 to similar effect in a medical malpractice case. The Hamil court concluded that where there is evidence that a defendant increased the risk of harm, "such evidence furnishes a basis for the fact-finder to go further and find that such increased risk was in turn a substantial factor in bringing about the resultant harm . . . .” Id., p 272. Thus the court accomplished an extraordinary transformation of traditional causation by allowing the jury to find causation in fact where the most that could be shown is that the defendant increased the risk of harm. As has been noted by courts criticizing the Hamil decision, § 323 simply establishes a duty where a person undertakes to render services to another to avoid increasing the risk of harm to the recipient. Curry v Summer, 136 Ill App 3d 468, 476; 483 NE2d 711 (1985). In order for liability to result from a violation of the duty described in § 323, the physical harm must "result[ ] from [the] failure to exercise reasonable care to perform [the] undertaking . . . .” Thus, the causation requirement is not obviated by § 323, as the court in Hamil effectively held. The court in Hamil need not have so drastically altered traditional concepts of causation, since there was evidence that the decedent would have had a seventy-five percent likelihood of survival absent defendant’s negligence.
Several courts have employed an inquiry similar to that of the Pennsylvania Supreme Court in *484Hamil. In Thornton v CAMC, 305 SE2d 316, 325 (W Va, 1983), the court held that a defendant would be liable where the plaintiff could show that the defendant’s acts or omissions increased the risk of harm and that such increased risk "was a substantial factor in bringing about the ultimate injury to the plaintiff . . . See also Aasheim v Humberger, 215 Mont 127, 146-147; 695 P2d 824 (1985); Sharp v Kaiser Foundation Health Plan of Colorado, 710 P2d 1153, 1156 (Colo App, 1985), aff’d 741 P2d 714 (Colo, 1987).10
While the court in Hamil openly recognized that the effect of the rule is "to relax the degree of certitude normally required of plaintiff’s evidence in order to make a case for the jury as to whether a defendant may be held liable for the plaintiff’s injuries,” id., p 269, others have avoided overt alteration of the meaning of causation by redefining the compensable injury not as the ultimate harm, but as the lost chance of avoiding that harm.
In Herskovits v Group Health Cooperative of Puget Sound, 99 Wash 2d 609; 664 P2d 474 (1983), the Washington Supreme Court faced a situation where the plaintiff, suffering from lung cancer, had less than a fifty percent chance of survival at all times, but the defendants’ negligence reduced the decedent’s chance of survival by thirty-six percent (from thirty-nine to twenty-five percent). In a concurring opinion, Judge Pearson noted that in medical malpractice cases, cause in fact "must be established beyond the balance of probabilities.” Id., p 622. Furthermore, plaintiff’s expert was unable to state that the defendants’ negligence *485probably or more likely than not caused the death of the decedent. However, if the injury were viewed as a reduction in the chance of survival, a different result could be reached; the plaintiff’s expert had testified that the failure to diagnose probably caused a substantial reduction in the decedent’s chance of survival.
In Waffen v United States Dep’t of Health & Human Services, 799 F2d 911, 917 (CA 4, 1986), the loss as a substantial chance of survival was recognized as a cognizable harm under Maryland law. The court thus avoided overt alteration of the rules of causation, holding that "plaintiff must submit proof that the injury complained of was 'more likely’ or 'more probably’ due to defendant’s action rather than to any other cause.” Id.
The lost chance theory is most fully explained in King, Causation, valuation, and chance in personal injury torts involving preexisting conditions and future consequences, 90 Yale L J 1353 (1981). The theory is premised on the reasoning that chance itself is an injury entitled to redress, and that chance should be measured by a mathematical percentage probability test:
Causation has for the most part been treated as an all-or-nothing proposition. Either a loss was caused by the defendant or it was not. Inexplicably, the all-or-nothing approach of the causation inquiry has been allowed to slip its analytical moorings, influencing the identification and valuation of losses in cases involving preexisting conditions and claims for future consequences. A plaintiff ordinarily should be required to prove by the applicable standard of proof that the defendant caused the loss in question. What caused a loss, however, should be a separate question from what the nature and extent of the loss are. This distinction seems to have eluded the courts, with the *486result that lost chances in many respects are compensated either as certainties or not at all.
To illustrate, consider the case in which a doctor negligently fails to diagnose a patient’s cancerous condition until it has become inoperable. Assume further that even with a timely diagnosis the patient would have had only a 30% chance of recovering from the disease and surviving over the long term. There are two ways of handling such a case. Under the traditional approach, this loss of a not-better-than-even chance of recovering from the cancer would not be compensable because it did not appear more likely [than] not that the patient would have survived with proper care. Recoverable damages, if any, would depend on the extent to which it appeared that cancer killed the patient sooner than it would have with timely diagnosis and treatment, and on the extent to which the delay in diagnosis aggravated the patient’s condition, such as by causing additional pain. A more rational approach, however, would allow recovery for the loss of the chance of cure even though the chance was not better than even. The probability of long-term survival would be reflected in the amount of damages awarded for the loss of the chance. While the plaintiff here could not prove by a preponderance of the evidence that he was denied a cure by the defendant’s negligence, he could show by a preponderance that he was deprived of a 30% chance of a cure. [Id., pp 1363-1364. Emphasis in original.]
A number of cases adopting the lost chance of survival theory also adopt Professor King’s statistical approach, holding that if a decedent had, for example, a thirty percent chance of survival, then compensation should be awarded for thirty percent of the value of the decedent’s life. See Boody v United States, 706 F Supp 1458, 1465 (D Kan, 1989); McKellips v St Francis Hosp, 741 P2d 467, 476 (Okla, 1987).
The number of jurisdictions adopting some ver-
*487sion of the lost chance of survival theory is fairly evenly matched by the number of states which continue to require that a defendant’s negligence probably caused the adverse result before a defendant is required to pay for the plaintiff’s damages.11 Many of these courts refer to the burden of proof for causation: a plaintiff must prove that the defendant’s negligence more likely than not caused the plaintiff’s injury. See, e.g., Cooper v Sisters of Charity of Cincinnati, 27 Ohio St 2d 242, 250-252; 272 NE2d 97 (1971); Weimer v Hetrick, 309 Md 536; 525 A2d 643 (1987).12 A number of courts, even while treating the matter as an issue of burden of proof, have recognized that the question goes to the heart of the meaning of causation. Thus, the New Hampshire Supreme Court wrote that "[c]ausation is a matter of probability, not possibility.” Pillsbury-Flood v Portsmouth Hosp, 128 NH 299, 305; 512 A2d 1126 (1986). The Florida Supreme Court in Gooding v Univ Hosp Bldg, Inc, 445 So 2d 1015, 1018 (Fla, 1984), cogently stated *488its reasons for declining to relax the causation requirement in medical malpractice cases:
Relaxing the causation requirement might correct a perceived unfairness to some plaintiffs who could prove the possibility that the medical malpractice caused an injury but could not prove the probability of causation, but at the same time could create an injustice. Health care providers could find themselves defending cases simply because a patient fails to improve or where serious disease processes are not arrested because another course of action could possibly bring a better result. No other professional malpractice defendant carries this burden of liability without the requirement that plaintiffs prove the alleged negligence probably rather than possibly caused the injury. We cannot approve the substitution of such an obvious inequity for a perceived one. [Id., pp 1019-1020. Citation omitted.]
IV
The lost chance of survival theory does more than merely lower the threshold of proof of causation; it fundamentally alters the meaning of causation.
The most fundamental premise upon which liability for a negligent act may be based is cause in fact. Glinski v Szylling, 358 Mich 182, 196-197; 99 NW2d 637 (1959). "An act or omission is not regarded as a cause of an event if the particular event would have occurred without it.” Prosser & Keeton, Torts (5th ed), § 41, p 265. If the defendant’s acts did not actually cause the plaintiff’s injury, then there is no rational justification for requiring the defendant to bear the cost of the plaintiff’s damages. Thus, it is the plaintiff’s burden to show a causal connection between negligence and injury. Glinski, supra, p 201. "A case cannot go to a jury supported merely by sheer speculation that something might have been a *489cause, or, going one step further, that there was a possibility that something was the cause.” Id., pp 201-202.
The recognition of a lost chance as a cognizable injury is necessarily based on the reasoning that but for the defendant’s negligence, the plaintiff might possibly have avoided an adverse result. Thus, recognition of lost chance as a recoverable interest contradicts the very notion of cause in fact. Professor King aptly characterizes a lost chance as a "raffle ticket” destroyed by the defendant’s negligence.13 King, supra, p 1378. King advocates compensation for "statistically demonstrable losses,” id., p 1377, so that a person deprived of a forty percent chance of survival should be compensated for forty percent of the compensable value of his life. Id., p 1382. Thus, tort law is transformed from a compensatory system to a payout scheme on the basis of a statistical chance that the defendant caused the plaintiff’s death. It is no answer that full compensation based on less than a certainty that a patient would have survived is overcompensation. Professor King criticizes the probability standard of causation because, in his Anew, it treats the better-than-even chance as a certainty, "as though it had materialized or were certain to do so.” Id., p 1387. Clearly, causation can never be proven to a certainty; the law settles for less in determining that a defendant should be held liable *490for damages to a plaintiff.14 Thus, Professor McCormick describes the preponderance of the evidence standard of proof in terms of "probability”:
The most acceptable meaning to be given to the expression, proof by a preponderance, seems to be proof which leads the jury to find that the existence of the contested fact is more probable than its nonexistence. Thus the preponderance of evidence becomes the trier’s belief in the preponderance of probability. [McCormick, Evidence (3d ed), § 339, p 957.]
McCormick notes that some courts are "shocked at the suggestion that a verdict, a truth-finding, should be based on nothing stronger than an estimate of probabilities.” Id., p 958. This statement reveals the very foundation of the tort system. Imperfect as it may be, our legal system attempts to ascertain facts to arrive at the truth. To protect the integrity of that goal, there must be some degree of certainty regarding causation before a jury may determine as fact that a medical defendant did cause the plaintiff’s injury and should therefore compensate the plaintiff in damages. To dispense with this requirement is to abandon the truth-seeking function of the law. Professor King is willing to do so in his attempt to compensate for the precise magnitude of any lost chance. Professor King’s criticism of the more likely than not standard for causation, like the lost chance theory itself, is based on the erroneous premise that it is the purpose of tort law to compensate for lost chances. But tort law should not operate by the *491same principles that govern lotteries and insurance policies. If the acts of the defendants did not actually cause plaintiff’s injury, then there is no rational justification for requiring defendants to bear the cost of plaintiff’s damages.
Even where there is causation in fact, a weighing of social interests requires a limit on how far the consequences of negligence will extend.
As a practical matter, legal responsibility must be limited to those causes which are so closely connected with the result and of such significance that the law is justified in imposing liability. Some boundary must be set to liability for the consequences of any act, upon the basis of some social idea of justice or policy. [Prosser & Keeton, Torts, 5th ed, § 41, p 264.]
Thus, "[b]y adjusting the causation requirement, the court is able to strike a balance between deterring harmful behavior and encouraging useful activity.” Abel v Eli Lilly & Co, 418 Mich 311, 324, n 8; 343 NW2d 164 (1984), cert den 469 US 833 (1984). If liability is to be imposed in proportion to any chance at survival, then the medical profession will be subjected to a burden which is not imposed on any other group of defendants. Cooper, supra. I submit that nothing is to be gained by extracting payment from a defendant who cannot be shown to have caused the adverse result. Such a rule will not serve the deterrence function of tort law. It more likely will encourage the practice of costly defensive medicine in an attempt to avoid practically certain liability in the event of an unfavorable outcome.
The utility of the physician’s conduct militates against a relaxation of the causation requirement in medical malpractice cases. "The physician serves a vital function in our society, a function *492which requires the assumption of a duty to the patient. Yet, his profession affords him only an inexact and often experimental science by which to discharge his duty.” Herskovits, supra, p 638 (Brachtenbach, J., dissenting). See also Malone, Ruminations on cause-in-fact, 9 Stan L R 60, 86-87 (1956). This is not similar to the case in which two shooters are held liable because it cannot be determined whose bullet caused the victim’s death, Summers v Tice, 33 Cal 2d 80; 199 P2d 1 (1948). Under those circumstances, the utility of the actors’ conduct is so low that it is not troubling to permit recovery against both on the theory of concert of action, even where causation can be attributed to neither by a preponderance of the evidence.15 See Prosser & Keeton, Torts, § 41, p 271. In Abel v Eli Lilly, supra, p 327, this Court discussed Summers v Tice and the rationale for its rule, which is embodied in 2 Restatement Torts, 2d, § 433B(3), comment f, p 446:
[T]he reason for the exception to traditional rules is to prevent the injustice of allowing proved ■wrongdoers to escape liability for an injury inflicted upon an innocent plaintiff "merely because the nature of their conduct and the resulting harm has made it difficult or impossible to prove which of them has caused the harm.”
The Court in Abel relied on this rationale to fashion a "DES-unique” theory of alternative liability, where it could be shown that all of the defendants acted tortiously, and that the plaintiff was harmed by the conduct of one of the defendants. *493Id., p 331. Assuming as we must that defendants Kelso and Memorial Hospital acted tortiously, there remains a crucial distinction between Abel and this case. In Abel, it was known that one of the defendants caused each plaintiff’s injury. In this case, the question is not who caused Nena Falcon’s death; the question, for which we have no answer, is whether any human act or omission caused her death. I do not mean to minimize the tragedy of such events, but only to question the assumption that a human cause may be located.
v
In this case, there is deposition testimony from which it could be inferred that the decedent was deprived of a 37.5 percent chance of survival by the failure of Dr. Kelso to insert an intravenous line before or immediately after the administration of a saddle block anaesthetic. Plaintiff does not assert that evidence showing any greater likelihood of survival will be produced at trial; it is plaintiff’s theory that the lost chance of survival should itself be compensated. Where the plaintiff can show no more than a possibility that the defendants’ conduct was a cause of the harm, I would conclude that the plaintiff has not produced adequate evidence to create a factual issue regarding causation. Rogers, Harvey, supra. Inherent in the concept of causation is a degree of certitude which is absolutely lacking in this case. Our case law wisely requires evidence from which it may be inferred that the defendant probably caused the ultimate harm before the jury may be allowed to infer that the defendant did cause such harm and should compensate the plaintiff in damages.
Also inherent in the concept of causation is the notion of foreseeability. The scope of liability *494should ordinarily extend to, but not beyond, the scope of the "foreseeable risks”—that is, the risks by reason of which the actor’s conduct is held negligent. Prosser & Keeton, §42, p 273. In this case, there is absolutely no evidence that the purpose of an intravenous line would have been to prevent an amniotic fluid embolism. Similarly, there is a total absence of evidence that the purpose of an intravenous line was to manage or treat this unpredictable complication of labor. Instead, all of plaintiff’s evidence points to the conclusion that the reason for inserting an intravenous line would have been to manage the potential complications of the saddle block anaesthetic. Under these circumstances, even assuming that compensation should be granted where defendant has caused the loss of a mere chance, plaintiff lacks evidence on which a showing of causation may be predicated. In other words, plaintiff cannot even prove that defendant caused the loss of a 37.5 percent chance of survival.
CONCLUSION
I disagree with the adoption of the lost chance of survival theory. The recovery of damages for the loss of a mere chance eviscerates the principles that underlie our tort law. By identifying the ultimate harm underlying a wrongful death action as the loss of a chance at survival, the lead opinion abandons the most fundamental negligence element of cause in fact. By definition, the recovery sanctioned today is based on the mere possibility that the acts of the defendants caused the death of Nena Falcon. I believe it is unwise to impose liability on members of the medical profession in such difficult circumstances as those now before this Court. Rather than deterring undesira*495ble conduct, the rule imposed only penalizes the medical professional for inevitable unfavorable results. The lost chance of survival theory presumes to know the unknowable. There is little satisfaction or comfort in the conclusion that we simply cannot know why Nena Falcon died. The desire to compensate for the chance that the decedent might have survived, while understandable, is not justifiable.
Brickley and Griffin, JJ., concurred with Riley, C.J.

MCL 600.2922; MSA 27A.2922.

 The procedural posture of this case requires us to presume that defendants breached the applicable standard of care. Counsel for defendant Memorial Hospital conceded at oral argument that there was evidence from which a jury could find that it was a breach of the standard of care not to use an intravenous line.

 While there was evidence that plaintiff was obese, a smoker, and suffering from a mild case of pneumonia at the time of the delivery, there is no record evidence that these factors put her at increased risk for amniotic fluid embolism.

 The amnion is "the innermost of the embryonic or fetal membranes . . . the sac in which the embryo is suspended.” The Random House College Dictionary, rev ed.

 The chorion is "the outermost of the extraembryonic membranes . . . .” The Random House College Dictionary, rev ed.

 Summary disposition is appropriate under MCR 2.116(0(10) when "[ejxcept as to the amount of damages, there is no genuine issue as to any material fact, and the moving party is entitled to judgment or partial judgment as a matter of law.” For purposes of reviewing the ruling under this subrule, we accept as true the deposition testimony of Drs. Abouleish and DeKornfeld that the failure to insert an intravenous catheter before or immediately after the administration of saddle block anaesthesia was a breach of the standard of care applicable to defendants at the time of the incident. We also take as true the allegations that the decedent would have had a 37.5 percent chance of survival if an intravenous line had been inserted, but because this was not done her chance of survival was eliminated.

 In Bell v United States, 854 F2d 881 (CA 6, 1988), the United States Court of Appeals for the Sixth Circuit rejected a "bright line” requirement that the plaintiff prove the defendant’s negligent failure to diagnose an aneurysm deprived him of a fifty-one percent chance of survival; the court correctly stated the Michigan rule as requiring proof that the deceased had a "reasonable probability” of recovery but for the defendant’s negligence. Id., p 883.

Interestingly the court in Hicks cited the Michigan case of Harvey, supra, for its statement that the law does not require proof to a certainty that the death of the decedent would have been avoided if not for the defendant’s negligence. In a footnote, the Hicks court correctly interpreted the holding in Harvey to be that because there was evidence that there was a probability that surgery would have saved the decedent’s life, the negligent diagnosis was the proximate cause of the decedent’s death. Hicks, supra, p 632, n 2.

 One who undertakes, gratuitously or for consideration, to render services to another which he should recognize as necessary for the protection of the other’s person or things, is subject to liability to the other for physical harm resulting from his failure to exercise reasonable care to perform his undertaking, if
(a) his failure to exercise such care increases the risk of such harm .... [2 Restatement Torts, 2d, § 323, p 135.]

 It is notable that a number of cases which have adopted the § 323 increased risk analysis have also limited the damages recoverable to those which the duty imposed was intended to prevent. Thompson v Sun City Community Hosp, 141 Ariz 597, 608; 688 P2d 605 (1984); McKellips v St Francis Hosp, 741 P2d 467 (Okla, 1987).

 Cases retaining the more likely than not standard for causation in medical malpractice cases include Alfonso v Lund, 783 F2d 958 (CA 10, 1986) (applying New Mexico law); Connellan v Coffey, 122 Conn 136; 187 A 901 (1936); LaBieniec v Baker, 11 Conn App 199; 526 A2d 1341 (1987); Gooding v Univ Hosp Bldg, Inc, 445 So 2d 1015, 1018 (Fla, 1984); Walden v Jones, 439 SW2d 571 (Ky, 1978); Anthony v Hosp Service Dist No 1, 477 So 2d 1180 (La App, 1985); Cornfeldt v Tongen, 295 NW2d 638 (Minn, 1980); Ladner v Campbell, 515 So 2d 882 (Miss, 1987); Pillsbury-Flood v Portsmouth Hosp, 128 NH 299; 512 A2d 1126 (1986); Cooper v Sisters of Charity of Cincinnati, 27 Ohio St 2d 242; 272 NE2d 97 (1971). There are several jurisdictions in which conflicting decisions exist, see 54 ALR4th 10, § 7, p 42.

 As noted, ante, pp 485-486, the United States Court of Appeals for the Fourth Circuit interpreted Maryland law to allow recovery for the loss of a chance of survival. Waffen, supra. The Maryland Court of Appeals in Weimer approved the traditional standard of proof for causation, but resolved the case solely by reference to Maryland’s wrongful death statute, which allowed an action against a person "whose wrongful act caused the death of another . . . .” Id., p 554. In Cooper v Hartman, 311 Md 259, 261; 533 A2d 1294 (1987), the Maryland Supreme Court expressly declined to decide whether to adopt the "lost chance” doctrine.

 This Court expressed its reluctance to compensate for mere chance when it held in Larson v Johns-Manville Sales Corp, 427 Mich 301, 305; 399 NW2d 1 (1986), that a plaintiff who contracts asbestosis but does not bring suit is not barred from later bringing suit when he knows or should know he has developed cancer as a result of the asbestosis. The Court reasoned:
Rather than encouraging every plaintiff who develops asbestosis to recover an amount of money as compensation for the chance of getting cancer, we prefer to allow those who actually do develop cancer to obtain a full recovery. [Id., p 319.]

McCormick notes that standards of proof ultimately are concerned with the state of the jury’s mind rather than the evidence itself. McCormick, Evidence (3d ed), § 339, p 956. Thus, the preponderance of the evidence standard properly refers not to the weight of evidence, but to the degree of certainty which it might inspire in the minds of jurors. Id.

 Nor can this case be compared with a situation in which a captain of a ship is held liable for failure to rescue a man overboard, where only a chance of survival could be shown had rescue been attempted. There is little imaginable utility in a decision by the ship’s captain to decline a rescue attempt. Gardner v Nat’l Bulk Carriers, supra.