Harnish v. Children's Hospital Medical Center
1982 Mass. LEXIS 1664, 387 Mass. 152, 439 N.E.2d 240 (1982)
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Rule of Law:
A physician has a duty to disclose to a patient all significant medical information that the physician possesses or should possess that is material to an intelligent decision by the patient whether to consent to a proposed procedure. Materiality is determined by what a reasonable person in the patient's position would consider significant, not by what physicians customarily disclose.
Facts:
- The plaintiff had a recurring tumor in her neck, known as a cystic hygroma, for which she had undergone several previous surgical procedures.
- The plaintiff agreed to undergo another operation at Children’s Hospital Medical Center, which she alleged was for purely cosmetic reasons.
- During the procedure, performed by Dr. Mulliken with assistance from Drs. Holmes and Gilman, the plaintiff's hypoglossal nerve was severed.
- The nerve severance resulted in a permanent and near-total loss of tongue function, causing severe difficulties with speech, chewing, and swallowing.
- Prior to the operation, Dr. Holmes discussed the procedure with the plaintiff but did not inform her of the foreseeable risk of nerve damage and subsequent loss of tongue function.
- The plaintiff alleged that if she had been informed of this specific risk, she would not have consented to the surgery.
Procedural Posture:
- The plaintiff sued Drs. Mulliken, Holmes, Gilman, and Children’s Hospital Medical Center in a Massachusetts trial court for negligence based on a lack of informed consent.
- Pursuant to state law, a medical malpractice tribunal was convened to review the plaintiff's claim.
- The tribunal found that the plaintiff's offer of proof was insufficient to raise a question appropriate for judicial inquiry.
- The trial court dismissed the action after the plaintiff failed to post a mandatory bond to continue the case following the tribunal's adverse finding.
- The plaintiff appealed the judgment of dismissal to the Supreme Judicial Court of Massachusetts.
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Issue:
Does a physician's duty to obtain a patient's informed consent require the disclosure of all information that a reasonable person in the patient's position would find material to their decision, rather than only the information that is customarily disclosed by other physicians in similar circumstances?
Opinions:
Majority - O'Connor
Yes. A physician's failure to divulge sufficient information to enable a competent adult patient to make an informed judgment whether to consent to a medical procedure constitutes professional misconduct. The court rejects the 'professional custom' standard, which measures a physician's disclosure duty by what other physicians customarily disclose. Instead, it adopts a 'reasonable patient' standard, rooted in the principle of bodily integrity and the patient's right to self-determination. Under this rule, a physician must disclose all significant medical information that they possess or should possess that is material to a patient's decision. Information is considered material if a reasonable person, in what the physician knows or should know is the patient's position, would be likely to attach significance to the risk in deciding whether to undergo the procedure. The determination of materiality is a question for a lay jury, not one that requires expert medical testimony. The court also held that this duty of disclosure applies to the surgeon in charge and any physician who undertakes to counsel the patient, but not to a mere surgical assistant or to a hospital in the absence of evidence that it controlled the surgeon's conduct.
Analysis:
This decision marks a significant shift in Massachusetts medical malpractice law by replacing the physician-centric 'customary practice' standard with the patient-centric 'reasonable patient' standard for informed consent. This change empowers patients by focusing on their informational needs for autonomous decision-making rather than on the habits of the medical profession. By defining materiality from the patient's perspective, the ruling makes it easier for plaintiffs to bring informed consent claims, as they may no longer need expert testimony to establish the standard of care for disclosure. The case solidifies the legal principle that patient autonomy is paramount and that physicians have an affirmative duty to facilitate it through adequate disclosure.
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