Aiken Ex Rel. Aiken v. Clary
1965 Mo. LEXIS 645, 396 S.W. 2d 668 (1965)
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Rule of Law:
In a medical malpractice action based on a physician's failure to obtain informed consent, the plaintiff must introduce expert medical testimony to establish the standard of care for what a reasonable medical practitioner would disclose about the risks of a proposed treatment.
Facts:
- In 1961, after experiencing significant personality changes, the plaintiff, Mr. Aiken, consulted with his doctor and was subsequently referred to Dr. William Clary, a psychiatrist.
- Dr. Clary diagnosed Aiken with paranoid schizophrenia and recommended a course of electric and insulin shock therapy.
- Dr. Clary informed Aiken that the therapy had risks, comparing them to the risks of anesthesia, but did not specifically disclose the risks of a prolonged coma, brain damage, or death.
- Aiken consented to the treatment and signed a form stating that the nature and hazards of the therapy had been fully explained to him.
- On June 22, 1961, during the course of his treatment, Aiken lapsed into a prolonged coma.
- As a result of the prolonged coma, Aiken suffered severe, permanent organic brain damage, rendering him totally disabled.
Procedural Posture:
- Aiken sued Dr. Clary for medical malpractice in a Missouri trial court.
- The case proceeded to a jury trial.
- The jury returned a verdict for the defendant, Dr. Clary.
- Aiken's motion for a new trial was denied by the trial court.
- Aiken, as the appellant, appealed the judgment to the Supreme Court of Missouri.
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Issue:
In a medical malpractice action alleging a physician's failure to provide adequate information for informed consent, must the plaintiff present expert medical testimony to establish the standard of what a reasonable physician would disclose under the same or similar circumstances?
Opinions:
Majority - Finch, Judge
Yes. In a medical malpractice case alleging lack of informed consent, the plaintiff must present expert medical testimony to establish the standard of care for disclosure. The question of what disclosures are required involves medical judgment, and is not a matter of common knowledge for lay jurors. The standard is not what a reasonable person would disclose, but what a reasonable medical practitioner would disclose, taking into account the patient's condition, the frequency and severity of risks, and the potential adverse psychological effects of disclosure on the patient. Because this determination requires professional skill and judgment, expert testimony is necessary to establish the standard against which the defendant-doctor's conduct is to be measured. The court overrules prior precedent, Mitchell v. Robinson, to the extent it held that expert testimony was not required in such cases. However, because the plaintiff reasonably relied on that prior precedent, the case is reversed and remanded for a new trial to allow the plaintiff an opportunity to present the required expert testimony.
Analysis:
This decision establishes the 'professional standard' (or 'physician-oriented standard') for informed consent in Missouri, aligning it with the traditional standard of care in other medical malpractice actions. By requiring expert testimony on the adequacy of disclosure, the court significantly increases the evidentiary burden and cost for plaintiffs in informed consent cases. This ruling marks a shift away from a 'patient-oriented' standard (what a reasonable patient would want to know), making it more difficult for juries to find a physician negligent without explicit guidance from a medical expert on what disclosures are customary within the medical profession.
