Matthies v. Mastromonaco
733 A.2d 456 (1999)
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Rule of Law:
A physician's duty to obtain a patient's informed consent requires the disclosure of medically reasonable treatment alternatives, both invasive and non-invasive, along with their associated risks and likely outcomes, even when the physician does not recommend those alternatives.
Facts:
- In 1990, Jean Matthies, an 81-year-old woman who lived independently, fell and fractured her hip.
- Dr. Edward Mastromonaco, an orthopedic surgeon, was consulted to treat Matthies.
- Due to Matthies's age, frail condition, osteoporosis, and history of a stroke, Dr. Mastromonaco determined that surgery to pin the hip would be too risky.
- Instead of surgery, Dr. Mastromonaco prescribed a non-invasive "bed-rest treatment," recognizing it was a "controversial" approach.
- Dr. Mastromonaco believed this conservative treatment was appropriate because he felt Matthies should live in a long-term care facility rather than returning to her independent lifestyle.
- During the bed-rest treatment, Matthies's femur displaced, her leg shortened, and she permanently lost the ability to walk.
- Matthies alleged that Dr. Mastromonaco never informed her that surgery was an alternative or warned her that bed rest could result in her never walking again.
- Dr. Mastromonaco contended that he discussed surgery with Matthies, but she refused it due to a fear of blood transfusions.
Procedural Posture:
- Jean Matthies sued Dr. Mastromonaco in the New Jersey Law Division (trial court) for medical malpractice and lack of informed consent.
- The trial court refused to allow the informed consent claim to go to the jury, ruling the doctrine only applied to invasive procedures.
- The jury returned a verdict for Dr. Mastromonaco on the medical malpractice claim.
- Matthies, as appellant, appealed to the New Jersey Appellate Division.
- The Appellate Division reversed the trial court, holding that informed consent applies to non-invasive treatments, and remanded for a new trial on both issues.
- Dr. Mastromonaco, as petitioner, appealed to the Supreme Court of New Jersey, which granted certification.
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Issue:
Does the doctrine of informed consent require a physician to disclose medically reasonable treatment alternatives, including their risks and likely outcomes, when the recommended course of treatment is non-invasive?
Opinions:
Majority - Pollock, J.
Yes, the doctrine of informed consent requires a physician to disclose all medically reasonable invasive and non-invasive treatment alternatives. Informed consent is a negligence concept based on a patient's right to self-determination, not a battery concept limited to physical invasion. The decisive factor is not whether a treatment is invasive, but whether the physician has provided sufficient information for a reasonable patient to make an informed decision. This duty requires the physician to explain all medically reasonable options, their risks, and their likely outcomes, even those the physician does not recommend. By withholding such information, the physician improperly usurps the patient's right to choose a course of treatment that aligns with their own values and risk tolerance, effectively making the decision for the patient.
Analysis:
This decision significantly clarifies and expands the doctrine of informed consent in New Jersey by untethering it from the historical tort of battery. By grounding informed consent in negligence and the right to self-determination, the court mandates that a physician's duty to inform is not limited to invasive procedures like surgery. This ruling reinforces the principle of patient autonomy over medical paternalism, requiring doctors to present a full slate of medically reasonable options, thereby empowering patients to make choices that reflect their own lifestyles and values, rather than the physician's. Future cases involving failure to disclose conservative or non-treatment options will now have a clear precedent to follow.
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