Arato v. Avedon
5 Cal. 4th 1172, 858 P.2d 598, 23 Cal. Rptr. 2d 131 (1993)
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Rule of Law:
A physician's duty of informed consent does not require the disclosure of a patient's statistical life expectancy as a matter of law. Instead, the duty is to disclose all material information that a reasonable person in the patient's position would find significant in making a treatment decision, and the materiality of specific information is a question for the jury based on the totality of the circumstances.
Facts:
- In 1980, Mildos Arato was diagnosed with pancreatic cancer after a tumor was discovered during surgery to remove a failing kidney.
- Upon referral to oncologists, including Dr. Avedon, Mr. Arato completed a questionnaire indicating he wished to be told the truth about his condition.
- The oncologists recommended a course of experimental chemotherapy and radiation (F.A.M. therapy), discussing its promising aspects and potential side effects.
- The physicians informed Mr. Arato that his cancer was serious, had a high risk of recurrence, and would be incurable if it returned, but they did not disclose specific statistical mortality rates for pancreatic cancer.
- The physicians testified they withheld statistics because Mr. Arato was anxious and they believed such data could deprive him of hope and had little predictive value for an individual.
- Mr. Arato consented to the treatment, which ultimately proved ineffective.
- Mr. Arato died from the cancer approximately one year after his initial surgery.
- His family alleged that his lack of knowledge about his bleak life expectancy caused him to neglect his business and financial affairs, leading to substantial losses after his death.
Procedural Posture:
- The wife and children of Mildos Arato (plaintiffs) sued his treating physicians (defendants) in a California trial court, alleging a failure to obtain informed consent.
- The jury returned a special verdict in favor of the defendants, finding they had disclosed all relevant information.
- Plaintiffs appealed the judgment to the California Court of Appeal.
- A divided Court of Appeal reversed the trial court's judgment and ordered a new trial, holding that the physicians had a duty to disclose statistical life expectancy information.
- The defendant physicians petitioned the Supreme Court of California for review.
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Issue:
Does the doctrine of informed consent require a physician to disclose a patient's statistical life expectancy information as a matter of law to enable the patient to make an informed decision regarding medical treatment?
Opinions:
Majority - Arabian, J.
No, the doctrine of informed consent does not require a physician to disclose a patient's statistical life expectancy information as a matter of law. A physician's duty is to disclose all material information needed for a patient to make an informed decision, and the determination of what is material is a fact-bound assessment for the jury. The court reasoned that requiring disclosure of a specific type of information, such as statistical mortality rates, is unwise because medical contexts are highly variable and individual patient needs differ greatly. Such statistics are often unreliable for individual patients and could be medically inadvisable by destroying hope. The court reaffirmed the patient-based standard from Cobbs v. Grant, where materiality is judged by what a reasonable person in the patient's position would find significant, a standard well-suited for a jury's determination. Furthermore, the physician's duty of disclosure is limited to information relevant to medical treatment decisions, not the patient's nonmedical interests like business or financial planning.
Analysis:
This decision solidifies the patient-based standard of materiality in informed consent cases in California, but clarifies that it does not create a rigid checklist of required disclosures. By refusing to mandate the disclosure of statistical life expectancy, the court preserved the flexibility of the physician-patient relationship and underscored the jury's role as the ultimate arbiter of what information is material in a specific context. The ruling resists a trend toward requiring specific, quantitative disclosures, emphasizing instead a holistic, qualitative assessment of the information provided. It also firmly limits the scope of a physician's duty to matters of medical decision-making, rejecting the idea that doctors must act as financial or estate planning advisors.
