Kaplan v. Haines
232 A.2d 840, 96 N.J. Super. 242 (1967)
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Rule of Law:
In determining whether a physician obtained informed consent, the standard for disclosure is what a reasonable medical practitioner would disclose under similar circumstances. A jury may also consider the patient's own appreciation of the surgical risks, regardless of the source of that knowledge, in deciding whether consent was truly informed.
Facts:
- Johanna Kaplan, who had a history of coccyx injuries, consulted Dr. Keith Haines for a dull ache in her lower buttocks and radiating leg pain.
- Dr. Haines diagnosed Kaplan with degenerative arthritis at the lumbosacral joint and recommended hospitalization for traction therapy.
- When traction failed to relieve Kaplan's pain, a myelogram was performed, which revealed 'minimal defects' but was not conclusive for a herniated disc.
- Dr. Haines and the Kaplans offered conflicting accounts of their pre-operative discussions. Dr. Haines testified that he presented surgery as an option for pain that was otherwise untreatable, while Kaplan testified he warned she would become a 'wheel chair case' if she refused an immediate 'disc operation'.
- The Kaplans consented to an operation, and on November 24, 1961, Dr. Haines performed a spinal fusion and removed a 'bulging' portion of a disc that had not ruptured.
- Post-operatively, Kaplan developed a staphylococcus infection at the incision site, which necessitated a second operation for the removal of the original bone graft.
Procedural Posture:
- Johanna and Sidney Kaplan sued Dr. Keith Haines in a New Jersey trial court, alleging medical malpractice.
- The case was tried before a jury, which returned a verdict of no cause for action in favor of Dr. Haines.
- The trial court entered a judgment for Dr. Haines based on the jury's verdict.
- The Kaplans filed a motion for a new trial, which the trial court denied.
- The Kaplans, as appellants, appealed the judgment and the denial of the new trial motion to the Superior Court of New Jersey, Appellate Division.
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Issue:
In a medical malpractice case alleging lack of informed consent, is it permissible for a jury to consider evidence that the patient fully appreciated the dangers involved in the proposed surgery, even if that appreciation came from sources other than the physician's disclosure?
Opinions:
Majority - Lewis, J.A.D.
Yes, it is permissible for a jury to consider a patient's own appreciation of the dangers involved in a proposed surgery. A physician's duty is to make such disclosure as a reasonable medical specialist would make under similar circumstances. However, the law does not require disclosure of all remote possibilities, and in determining whether a patient gave an informed consent, the jury can and should consider the patient's own understanding of the procedure and its inherent risks, whatever the source of that understanding. In this case, Mrs. Kaplan recognized it was a 'serious operation,' had an extensive history of prior surgeries, and conferred with her husband, a lawyer, before consenting. Therefore, it was not error to instruct the jury to consider her appreciation of the dangers involved.
Dissenting - Labrecque, J.A.D.
No, the judgment should not be affirmed due to prejudicial errors in the jury instructions. The trial court improperly instructed the jury that the plaintiff had to prove the defendant's negligence was 'the' proximate cause of her injuries, rather than 'a' proximate cause, which placed an undue burden on the plaintiffs. This error, combined with an instruction to disregard the post-operative staphylococcus infection when considering damages, had a clear capacity to mislead the jury and was not harmless. These errors collectively warrant a reversal and a new trial.
Analysis:
This decision solidifies the 'reasonable medical practitioner' standard for informed consent in New Jersey, focusing on what a typical doctor in the field would disclose. More significantly, it introduces a subjective element by allowing the patient's own knowledge and experience to be considered by the jury. This potentially weakens claims from sophisticated or medically experienced patients, as their background appreciation of risk can be used to argue that their consent was, in fact, informed, even if the doctor's specific disclosures were incomplete. The case shifts the inquiry from solely what the doctor said to a broader context that includes the patient's understanding.
