Largey v. Rothman
110 N.J. 204, 540 A.2d 504 (1988)
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Rule of Law:
In a medical malpractice action for lack of informed consent, the standard for a physician's duty to disclose risks is what a prudent patient would find material to their decision-making process, not what a reasonable physician would disclose.
Facts:
- During a routine physical exam, Janice Largey's gynecologist detected a mass in her right breast.
- Mammograms revealed an ill-defined density in the breast and an enlarged lymph node in her right armpit.
- Largey was referred to Dr. Rothman, a surgeon, who recommended a biopsy of the breast tissue and the axillary lymph nodes, citing concern for cancer.
- Dr. Rothman performed the biopsy, removing both breast tissue and the lymph nodes.
- Prior to the procedure, Dr. Rothman did not inform Largey of the risk of developing lymphedema, a persistent swelling, as a result of the lymph node removal.
- The biopsies of both the breast tissue and the lymph nodes showed the specimens were benign.
- Approximately six weeks after the surgery, Largey developed lymphedema in her right arm and hand, a condition caused by the excision of her lymph nodes.
Procedural Posture:
- Janice Largey and her husband sued Dr. Rothman in a New Jersey trial court for medical malpractice based on claims of battery and lack of informed consent.
- The trial court instructed the jury on informed consent using the 'professional' standard, which measures the physician's duty by what a reasonable practitioner would disclose.
- The jury returned a verdict in favor of Dr. Rothman.
- The Largeys, as appellants, appealed to the Appellate Division of the Superior Court of New Jersey.
- The Appellate Division affirmed the trial court's judgment, holding that it was bound by existing state supreme court precedent establishing the 'professional' standard.
- The Largeys, as petitioners, successfully petitioned the Supreme Court of New Jersey for certification to review the standard for informed consent.
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Issue:
Does the doctrine of informed consent require a physician to disclose risks that a reasonable medical practitioner would disclose (the professional standard), or does it require disclosure of all risks that a reasonable patient would find material in making a treatment decision (the prudent patient standard)?
Opinions:
Majority - Per Curiam
The doctrine requires disclosure of all risks that a reasonable patient would find material in making a treatment decision. This court abandons the 'professional' standard, which bases the duty to disclose on what a reasonable physician would tell a patient, and adopts the 'prudent patient' standard. The court reasoned that the 'professional' standard is paternalistic and undermines a patient's fundamental right to self-determination over their own body. The 'prudent patient' standard, articulated in Canterbury v. Spence, correctly focuses on the patient's informational needs. Under this standard, a risk is 'material' if a reasonable patient, in what the physician knows or should know to be the patient's position, would be likely to attach significance to the risk in deciding whether to undergo the therapy. The court also adopted an objective test for causation, requiring the plaintiff to prove that a prudent person in the patient's position would have declined the treatment if adequately informed of the risk that resulted in harm.
Analysis:
This decision marks a significant shift in New Jersey's informed consent jurisprudence, moving from a physician-centric standard to a patient-centric one. By adopting the 'prudent patient' standard from Canterbury v. Spence, the court empowered patients and simplified the plaintiff's burden of proof. Plaintiffs no longer need to find a medical expert to testify about the professional standard of disclosure, which was often difficult due to the 'community of silence.' Instead, the determination of whether a risk was material is a question for the jury, focusing on what a reasonable person would want to know, thereby reinforcing the principle of patient autonomy in medical decision-making.
